Category Archives: Psoriasis

Post navigation

Articles OnWhat Is Psoriasis? What Is Psoriasis? What Is Psoriasis? – Understanding Psoriasis — the Basics What Is Psoriasis?

Unpredictable and irritating, psoriasis is one of the most baffling and persistent of skin disorders. It’s characterized by skin cells that multiply up to 10 times faster than normal. As underlying cells reach the skin’s surface and die, their sheer volume causes raised, red plaques covered with white scales. Psoriasis typically occurs on the knees, elbows, and scalp, and it can also affect the torso, palms, and soles of the feet.

The symptoms of psoriasis vary depending on the type you have. Some common symptoms for plaque psoriasis — the most common variety of the condition — include:

Psoriasis can also be associated with psoriatic arthritis, which leads to pain and swelling in the joints. The National Psoriasis Foundation estimates that between 10% to 30% of people with psoriasis also have psoriatic arthritis.

Other forms of psoriasis include:

Pustular psoriasis , characterized by red and scaly skin on the palms of the hands and/or feet with tiny pustules

Guttate psoriasis, which often starts in childhood or young adulthood, is characterized by small, red spots, mainly on the torso and limbs. Triggers may be respiratory infections, strep throat, tonsillitis, stress, injury to the skin, and use of anti-malarial and beta-blocker medications.

Inverse psoriasis, characterized by bright red, shiny lesions that appear in skin folds, such as the armpits, groin area, and under the breasts

Erythrodermic psoriasis, characterized by periodic, fiery redness of the skin and shedding of scales in sheets; this form of psoriasis, triggered by withdrawal from a systemic psoriasis treatment, severe sunburn, infection, and certain medications, requires immediate medical treatment, because it can lead to severe illness.

People who suffer from psoriasis know that this uncomfortable and at times disfiguring skin disease can be difficult and frustrating to treat. The condition comes and goes in cycles of remissions and flare-ups over a lifetime. While there are medications and other therapies that can help to clear up the patches of red, scaly, thickened skin that are the hallmark of psoriasis, there is no cure.

A variety of factors — ranging from emotional stress and trauma to streptococcal infection — can cause an episode of psoriasis. Recent research indicates that some abnormality in the immune system is the key cause of psoriasis. As many as 80% of people having flare-ups report a recent emotional trauma, such as a new job or the death of a loved one. Most doctors believe such external stressors serve as triggers for an inherited defect in immune function.

Psoriasis tends to run in families, but it may be skip generations; a grandfather and his grandson may be affected, but the child’s mother never develops the disease. Although psoriasis may be stressful and embarrassing, most outbreaks are relatively harmless. With appropriate treatment, symptoms generally subside within a few months.

SOURCES: National Institute of Arthritis and Musculoskeletal and Skin Disease. National Psoriasis Foundation. The Psoriasis Foundation. American Academy of Dermatology.

It’s easy to think of psoriasis as just a “skin condition.” But psoriasis actually starts underneath the skin. It is a chronic (long-lasting) disease of the immune system that can range from mild to severe.

Like most chronic illnesses, psoriasis may be associated with other health conditions such as psoriatic arthritis, Type 2 diabetes, and cardiovascular disease.

The good news is that there are available treatment options and strategies that can help you live well with psoriasis. Start here by learning as much as you can about psoriasis and exploring it from the inside out.

To fully understand psoriasis, you need to see whats happening underneath the skin.

What you’re watching is an example of what happens underneath your skin when you have plaque psoriasis.

While symptoms may appear on the surface of the skin, what you can see is only part of the story.

With normal skin, your body takes about 28 to 30 days to produce new skin cells and shed the old ones.

When your body has plaque psoriasis, your immune system is overactive, triggering skin inflammation and causing skin cells to be produced faster than normal. New skin cells are pushed to the skin’s surface in 3 to 4 days instead of the usual 28 to 30.

But your body can’t shed the new skin cells at that fast of a rate. So while new skin cells are being produced, the old, dead skin cells pile up on top of each other.

As more and more new skin cells are produced rapidly, the old skin cells are pushed to the surface, forming the thick, red, itchy, flaky patches known as plaques.

Psoriasis is a noncontagious, chronic skin condition that produces plaques of thickened, scaling skin. The dry flakes of skin scales result from the excessively rapid proliferation of skin cells. The proliferation of skin cells is triggered by inflammatory chemicals produced by specialized white blood cells called T-lymphocytes. Psoriasis commonly affects the skin of the elbows, knees, and scalp.

The spectrum of disease ranges from mild with limited involvement of small areas of skin to large, thick plaques to red inflamed skin affecting the entire body surface.

Psoriasis is considered an incurable, long-term (chronic) inflammatory skin condition. It has a variable course, periodically improving and worsening. It is not unusual for psoriasis to spontaneously clear for years and stay in remission. Many people note a worsening of their symptoms in the colder winter months.

Psoriasis affects all races and both sexes. Although psoriasis can be seen in people of any age, from babies to seniors, most commonly patients are first diagnosed in their early adult years. The quality of life of patients with psoriasis is often diminished because of the appearance of their skin. Recently, it has become clear that people with psoriasis are more likely to have diabetes, high blood lipids, cardiovascular disease, and a variety of other inflammatory diseases. This may reflect an inability to control inflammation. Caring for psoriasis takes medical teamwork.

No. Psoriasis is not contagious. Psoriasis is not transmitted sexually or by physical contact. Psoriasis is not caused by lifestyle, diet, or bad hygiene.

While the exact cause of psoriasis is unknown, researchers consider environmental, genetic, and immune system factors as playing roles in the establishment of the disease.

What are psoriasis causes and risk factors?

The exact cause remains unknown. A combination of elements, including genetic predisposition and environmental factors, are involved. It is common for psoriasis to be found in members of the same family. Defects in immune regulation and the control of inflammation are thought to play major roles. Certain medications like beta-blockers have been linked to psoriasis. Despite research over the past 30 years, the “master switch” that turns on psoriasis is still a mystery.

What are the different types of psoriasis?

There are several different forms of psoriasis, including plaque psoriasis or psoriasis vulgaris (common plaque type), guttate psoriasis (small, drop-like spots), inverse psoriasis (in the folds like of the underarms, navel, groin, and buttocks), and pustular psoriasis (small pus-filled yellowish blisters). When the palms and the soles are involved, this is known as palmoplantar psoriasis. In erythrodermic psoriasis, the entire skin surface is involved with the disease. Patients with this form of psoriasis often feel cold and may develop congestive heart failure if they have a preexisting heart problem. Nail psoriasis produces yellow pitted nails that can be confused with nail fungus. Scalp psoriasis can be severe enough to produce localized hair loss, plenty of dandruff, and severe itching.

Can psoriasis affect my joints?

Yes, psoriasis is associated with inflamed joints in about one-third of those affected. In fact, sometimes joint pains may be the only sign of the disorder, with completely clear skin. The joint disease associated with psoriasis is referred to as psoriatic arthritis. Patients may have inflammation of any joints (arthritis), although the joints of the hands, knees, and ankles tend to be most commonly affected. Psoriatic arthritis is an inflammatory, destructive form of arthritis and needs to be treated with medications in order to stop the disease progression.

The average age for onset of psoriatic arthritis is 30-40 years of age. Usually, the skin symptoms and signs precede the onset of the arthritis.

Can psoriasis affect only my nails?

Yes, psoriasis may involve solely the nails in a limited number of patients. Usually, the nail signs accompany the skin and arthritis symptoms and signs. Nail psoriasis is typically very difficult to treat. Treatment options are somewhat limited and include potent topical steroids applied at the nail-base cuticle, injection of steroids at the nail-base cuticle, and oral or systemic medications as described below for the treatment of psoriasis.

What are psoriasis symptoms and signs? What does psoriasis look like?

Plaque psoriasis signs and symptoms appear as red or pink small scaly bumps that merge into plaques of raised skin. Plaque psoriasis classically affects skin over the elbows, knees, and scalp and is often itchy. Although any area may be involved, plaque psoriasis tends to be more common at sites of friction, scratching, or abrasion. Sometimes pulling off one of these small dry white flakes of skin causes a tiny blood spot on the skin. This is a special diagnostic sign in psoriasis called the Auspitz sign.

Fingernails and toenails often exhibit small pits (pinpoint depressions) and/or larger yellowish-brown separations of the nail from the nail bed at the fingertip called distal onycholysis. Nail psoriasis may be confused with and incorrectly diagnosed as a fungal nail infection.

Guttate psoriasis symptoms and signs include bumps or small plaques ( inch or less) of red itchy, scaling skin that may appear explosively, affecting large parts of the skin surface simultaneously, after a sore throat.

In inverse psoriasis, genital lesions, especially in the groin and on the head of the penis, are common. Psoriasis in moist areas like the navel or the area between the buttocks (intergluteal folds) may look like flat red plaques without much scaling. This may be confused with other skin conditions like fungal infections, yeast infections, allergic rashes, or bacterial infections.

Symptoms and signs of pustular psoriasis include at rapid onset of groups of small bumps filled with pus on the torso. Patients are often systemically ill and may have a fever.

Erythrodermic psoriasis appears as extensive areas of red skin often involving the entire skin surface. Patients may often feel chilled.

Scalp psoriasis may look like severe dandruff with dry flakes and red areas of skin. It can be difficult to differentiate between scalp psoriasis and seborrheic dermatitis when only the scalp is involved. However, the treatment is often very similar for both conditions.

How do health care professionals diagnose psoriasis?

The diagnosis of psoriasis is typically made by obtaining information from the physical examination of the skin, medical history, and relevant family health history.

Sometimes lab tests, including a microscopic examination of tissue obtained from a skin biopsy, may be necessary.

Eczema vs. psoriasis

Occasionally, it can be difficult to differentiate eczematous dermatitis from psoriasis. This is when a biopsy can be quite valuable to distinguish between the two conditions. Of note, both eczematous dermatitis and psoriasis often respond to similar treatments. Certain types of eczematous dermatitis can be cured where this is not the case for psoriasis.

How many people have psoriasis?

Psoriasis is a fairly common skin condition and is estimated to affect approximately 1%-3% of the U.S. population. It currently affects roughly 7.5 million to 8.5 million people in the U.S. It is seen worldwide in about 125 million people. Interestingly, African Americans have about half the rate of psoriasis as Caucasians.

Is psoriasis contagious?

No. A person cannot catch it from someone else, and one cannot pass it to anyone else by skin-to-skin contact. Directly touching someone with psoriasis every day will never transmit the condition.

Is there a cure for psoriasis?

No, psoriasis is not currently curable. However, it can go into remission, producing an entirely normal skin surface. Ongoing research is actively making progress on finding better treatments and a possible cure in the future.

Is psoriasis hereditary?

Although psoriasis is not contagious from person to person, there is a known hereditary tendency. Therefore, family history is very helpful in making the diagnosis.

What health care specialists treat psoriasis?

Dermatologists are doctors who specialize in the diagnosis and treatment of psoriasis, and rheumatologists specialize in the treatment of joint disorders and psoriatic arthritis. Many kinds of doctors may treat psoriasis, including dermatologists, family physicians, internal medicine physicians, rheumatologists, and other medical doctors. Some patients have also seen other allied health professionals such as acupuncturists, holistic practitioners, chiropractors, and nutritionists.

The American Academy of Dermatology and the National Psoriasis Foundation are excellent sources to help find doctors who specialize in this disease. Not all dermatologists and rheumatologists treat psoriasis. The National Psoriasis Foundation has one of the most up-to-date databases of current psoriasis specialists.

It is now apparent that patients with psoriasis are prone to a variety of other disease conditions, so-called comorbidities. Cardiovascular disease, diabetes, hypertension, inflammatory bowel disease, hyperlipidemia, liver problems, and arthritis are more common in patients with psoriasis. It is very important for all patients with psoriasis to be carefully monitored by their primary care providers for these associated illnesses. The joint inflammation of psoriatic arthritis and its complications are frequently managed by rheumatologists.

What are psoriasis treatment options?

There are many effective psoriasis treatment choices. The best treatment is individually determined by the treating doctor and depends, in part, on the type of disease, the severity, and amount of skin involved and the type of insurance coverage.

For mild disease that involves only small areas of the body (less than 10% of the total skin surface), topical treatments (skin applied), such as creams, lotions, and sprays, may be very effective and safe to use. Occasionally, a small local injection of steroids directly into a tough or resistant isolated psoriatic plaque may be helpful.

For moderate to severe disease that involves much larger areas of the body (>10% or more of the total skin surface), topical products may not be effective or practical to apply. This may require ultraviolet light treatments or systemic (total body treatments such as pills or injections) medicines. Internal medications usually have greater risks. Because topical therapy has no effect on psoriatic arthritis, systemic medications are generally required to stop the progression to permanent joint destruction.

It is important to keep in mind that as with any medical condition, all medicines carry possible side effects. No medication is 100% effective for everyone, and no medication is 100% safe. The decision to use any medication requires thorough consideration and discussion with your health care provider. The risks and potential benefit of medications have to be considered for each type of psoriasis and the individual. Of two patients with precisely the same amount of disease, one may tolerate it with very little treatment, while the other may become incapacitated and require treatment internally.

A proposal to minimize the toxicity of some of these medicines has been commonly called “rotational” therapy. The idea is to change the anti-psoriasis drugs every six to 24 months in order to minimize the toxicity of one medication. Depending on the medications selected, this proposal can be an option. An exception to this proposal is the use of the newer biologic medications as described below. An individual who has been using strong topical steroids over large areas of their body for prolonged periods may benefit from stopping the steroids for a while and rotating onto a different therapy.

Coal tar shampoos are very useful in controlling psoriasis of the scalp. Using the shampoo daily can be very beneficial adjunctive therapy. There are a variety of shampoos available without a prescription. There is no evidence that one shampoo is superior to another. Generally, the selection of a tar shampoo is simply a matter of personal preference.

What oral medications are available for psoriasis?

Oral medications include methotrexate (Trexall), acitretin (Soriatane), cyclosporine (Neoral), apremilast (Otezla), and others. Oral prednisone (corticosteroid) is generally not used in psoriasis and may cause a disease flare-up if administered.

By clicking “Submit,” I agree to the MedicineNet Terms and Conditions and Privacy Policy. I also agree to receive emails from MedicineNet and I understand that I may opt out of MedicineNet subscriptions at any time.

What injections or infusions are available for psoriasis?

Recently, a new group of drugs called biologics have become available to treat psoriasis and psoriatic arthritis. They are produced by living cells cultures in an industrial setting. They are all proteins and therefore must be administered through the skin because they would otherwise be degraded during digestion. All biologics work by suppressing certain specific portions of the immune inflammatory response that are overactive in psoriasis. A convenient method of categorizing these drugs is on the basis of their site of action:

Drug choice can be complicated, and your physician will help in selecting the best option. In some patients. it may be possible to predict drug efficacy on the basis of a prospective patient’s genetics. It appears that the presence of the HLA-Cw6 gene is correlated with a beneficial response to ustekinumab.

Newer drugs are in development and no doubt will be available in the near future. As this class of drugs is fairly new, ongoing monitoring and adverse effect reporting continues and long-term safety continues to be monitored. Biologics are all comparatively expensive especially in view of the fact they none of them are curative. Recently, the FDA has attempted to address this problem by permitting the use of “biosimilar” drugs. These drugs are structurally identical to a specific biologic drug and are presumed to produce identical therapeutic responses in human beings to the original, but are produced using different methodology. Biosimilars ought to be available at some fraction of the cost of the original. If this will be an effective approach remains to be seen. The only biosimilar available currently is infliximab (Inflectra). Two other biosimilar drugs have been accepted by the FDA, an etanercept equivalent (Erelzi) and an adalimumab equivalent (Amjevita) — but currently, neither are available.

Some biologics are to be administered by self-injections for home use while others are given by intravenous infusions in the doctor’s office. Biologics have some screening requirements such as a tuberculosis screening test (TB skin test or PPD test) and other labs prior to starting therapy. As with any drug, side effects are possible with all biologic drugs. Common potential side effects include mild local injection-site reactions (redness and tenderness). There is concern of serious infections and potential malignancy with nearly all biologic drugs. Precautions include patients with known or suspected hepatitis B infection, active tuberculosis, and possibly HIV/AIDS. As a general consideration, these drugs may not be an ideal choice for patients with a history of cancer and patients actively undergoing cancer therapy. In particular, there may be an increased association of lymphoma in patients taking a biologic.

Biologics are expensive medications ranging in price from several to tens of thousands of dollars per year per person. Their use may be limited by availability, cost, and insurance approval. Not all insurance drug plans fully cover these drugs for all conditions. Patients need to check with their insurance and may require a prior authorization request for coverage approval. Some of the biologic manufacturers have patient-assistance programs to help with financial issues. Therefore, choice of the right medication for your condition depends on many factors, not all of them medical. Additionally, convenience of receiving the medication and lifestyle affect the choice of the right biologic medication.

Is there an anti-psoriasis diet?

Most patients with psoriasis seem to be overweight. Since there is a predisposition for those patients to develop cardiovascular disease and diabetes, it is suggested strongly that they try to maintain a normal body weight. Although evidence is sparse, it has been suggested that slender patients are more likely to respond to treatment.

Although dietary studies are notoriously difficult to perform and interpret, it seems likely that a diet whose fat content is composed of polyunsaturated oils like olive oil and fish oil is beneficial for psoriasis. The so-called Mediterranean diet is an example.

What about light therapy for psoriasis?

Light therapy is also called phototherapy. There are several types of medical light therapies that include PUVA (an acronym for psoralen + UVA), UVB, and narrow-band UVB. These artificial light sources have been used for decades and generally are available in only certain physician’s offices. There are a few companies who may sell light boxes or light bulbs for prescribed home light therapy.

Natural sunlight is also used to treat psoriasis. Daily short, controlled exposures to natural sunlight may help or clear psoriasis in some patients. Skin unaffected by psoriasis and sensitive areas such as the face and hands may need to be protected during sun exposure.

There are also multiple newer light sources like lasers and photodynamic therapy (use of a light activating medication and a special light source) that have been used to treat psoriasis.

PUVA is a special treatment using a photosensitizing drug and timed artificial-light exposure composed of wavelengths of ultraviolet light in the UVA spectrum. The photosensitizing drug in PUVA is called psoralen. Both the psoralen and the UVA light must be administered within one hour of each other for a response to occur. These treatments are usually given in a physician’s office two to three times per week. Several weeks of PUVA is usually required before seeing significant results. The light exposure time is gradually increased during each subsequent treatment. Psoralens may be given orally as a pill or topically as a bath or lotion. After a short incubation period, the skin is exposed to a special wavelength of ultraviolet light called UVA. Patients using PUVA are generally sun sensitive and must avoid sun exposure for a period of time after PUVA. Common side effects with PUVA include burning, aging of the skin, increased brown spots called lentigines, and an increased risk of skin cancer, including melanoma. The relative increase in skin cancer risk with PUVA treatment is controversial. PUVA treatments need to be closely monitored by a physician and discontinued when a maximum number of treatments have been reached.

Narrow-band UVB phototherapy is an artificial light treatment using very limited wavelengths of light. It is frequently given daily or two to three times per week. UVB is also a component of natural sunlight. UVB dosage is based on time and exposure is gradually increased as tolerated. Potential side effects with UVB include skin burning, premature aging, and possible increased risk of skin cancer. The relative increase in skin cancer risk with UVB treatment needs further study but is probably less than PUVA or traditional UVB.

Sometimes UVB is combined with other treatments such as tar application. Goeckerman is a special psoriasis therapy using this combination. Some centers have used this therapy in a “day care” type of setting where patients are in the psoriasis treatment clinic all day for several weeks and go home each night.

Recently, a laser (excimer laser XTRAC) has been developed that generates ultraviolet light in the same range as narrow-band ultraviolet light. This light can be beneficial for psoriasis localized to small areas of skin like the palms, soles, and scalp. It is impractical to use in in extensive disease.

What is the long-term prognosis with psoriasis? What are complications of psoriasis?

Overall, the prognosis for most patients with psoriasis is good. While it is not curable, it is controllable. As described above, recent studies show an association of psoriasis and other medical conditions, including obesity, diabetes, and heart disease.

Is it possible to prevent psoriasis?

Since psoriasis is inherited, it is impossible at this time to suggest anything that is likely to prevent its development aside from indulging in a healthy lifestyle.

What does the future hold for psoriasis?

Psoriasis research is heavily funded and holds great promise for the future. Just the last five to 10 years have produced great improvements in treatment of the disease with medications aimed at controlling precise sites of the process of inflammation. Ongoing research is needed to decipher the ultimate underlying cause of this disease.

Is there a national psoriasis support group?

Yes, the National Psoriasis Foundation (NPF) is an organization dedicated to helping patients with psoriasis and furthering research in this field. They hold national and local chapter meetings. The NPF web site (http://www.psoriasis.org/home/) shares up-to-date reliable medical information and statistics on the condition.

There are many ongoing clinical trials for psoriasis all over the United States and in the world. Many of these clinical trials are ongoing at academic or university medical centers and are frequently open to patients without cost.

Clinical trials frequently have specific requirements for types and severity of psoriasis that may be enrolled into a specific trial. Patients need to contact these centers and inquire regarding the specific study requirements. Some studies have restrictions on what recent medications have been used for psoriasis, current medication, and overall health.

Some of the many medical centers in the U.S. offering clinical trials for psoriasis include the University of California, San Francisco Department of Dermatology, the University of California, Irvine Department of Dermatology, and the St. Louis University Medical School.

Psoriasis is a common skin condition that speeds up the life cycle of skin cells. It causes cells to build up rapidly on the surface of the skin. The extra skin cells form scales and red patches that are itchy and sometimes painful.

Psoriasis is a chronic disease that often comes and goes. The main goal of treatment is to stop the skin cells from growing so quickly.

There is no cure for psoriasis, but you can manage symptoms. Lifestyle measures, such as moisturizing, quitting smoking and managing stress, may help.

Psoriasis care at Mayo Clinic

Psoriasis signs and symptoms are different for everyone. Common signs and symptoms include:

Psoriasis patches can range from a few spots of dandruff-like scaling to major eruptions that cover large areas.

Most types of psoriasis go through cycles, flaring for a few weeks or months, then subsiding for a time or even going into complete remission.

There are several types of psoriasis. These include:

Guttate psoriasis. This type primarily affects young adults and children. It’s usually triggered by a bacterial infection such as strep throat. It’s marked by small, water-drop-shaped, scaling lesions on your trunk, arms, legs and scalp.

The lesions are covered by a fine scale and aren’t as thick as typical plaques are. You may have a single outbreak that goes away on its own, or you may have repeated episodes.

Pustular psoriasis. This uncommon form of psoriasis can occur in widespread patches (generalized pustular psoriasis) or in smaller areas on your hands, feet or fingertips.

It generally develops quickly, with pus-filled blisters appearing just hours after your skin becomes red and tender. The blisters may come and go frequently. Generalized pustular psoriasis can also cause fever, chills, severe itching and diarrhea.

If you suspect that you may have psoriasis, see your doctor for an examination. Also, talk to your doctor if your psoriasis:

Seek medical advice if your signs and symptoms worsen or don’t improve with treatment. You may need a different medication or a combination of treatments to manage the psoriasis.

The cause of psoriasis isn’t fully understood, but it’s thought to be related to an immune system problem with T cells and other white blood cells, called neutrophils, in your body.

T cells normally travel through the body to defend against foreign substances, such as viruses or bacteria.

But if you have psoriasis, the T cells attack healthy skin cells by mistake, as if to heal a wound or to fight an infection.

Overactive T cells also trigger increased production of healthy skin cells, more T cells and other white blood cells, especially neutrophils. These travel into the skin causing redness and sometimes pus in pustular lesions. Dilated blood vessels in psoriasis-affected areas create warmth and redness in the skin lesions.

The process becomes an ongoing cycle in which new skin cells move to the outermost layer of skin too quickly in days rather than weeks. Skin cells build up in thick, scaly patches on the skin’s surface, continuing until treatment stops the cycle.

Just what causes T cells to malfunction in people with psoriasis isn’t entirely clear. Researchers believe both genetics and environmental factors play a role.

Psoriasis typically starts or worsens because of a trigger that you may be able to identify and avoid. Factors that may trigger psoriasis include:

Anyone can develop psoriasis, but these factors can increase your risk of developing the disease:

If you have psoriasis, you’re at greater risk of developing certain diseases. These include:

Articles OnWhat Is Psoriasis? What Is Psoriasis? What Is Psoriasis? – Understanding Psoriasis — the Basics What Is Psoriasis?

Unpredictable and irritating, psoriasis is one of the most baffling and persistent of skin disorders. It’s characterized by skin cells that multiply up to 10 times faster than normal. As underlying cells reach the skin’s surface and die, their sheer volume causes raised, red plaques covered with white scales. Psoriasis typically occurs on the knees, elbows, and scalp, and it can also affect the torso, palms, and soles of the feet.

The symptoms of psoriasis vary depending on the type you have. Some common symptoms for plaque psoriasis — the most common variety of the condition — include:

Psoriasis can also be associated with psoriatic arthritis, which leads to pain and swelling in the joints. The National Psoriasis Foundation estimates that between 10% to 30% of people with psoriasis also have psoriatic arthritis.

Other forms of psoriasis include:

Pustular psoriasis , characterized by red and scaly skin on the palms of the hands and/or feet with tiny pustules

Guttate psoriasis, which often starts in childhood or young adulthood, is characterized by small, red spots, mainly on the torso and limbs. Triggers may be respiratory infections, strep throat, tonsillitis, stress, injury to the skin, and use of anti-malarial and beta-blocker medications.

Inverse psoriasis, characterized by bright red, shiny lesions that appear in skin folds, such as the armpits, groin area, and under the breasts

Erythrodermic psoriasis, characterized by periodic, fiery redness of the skin and shedding of scales in sheets; this form of psoriasis, triggered by withdrawal from a systemic psoriasis treatment, severe sunburn, infection, and certain medications, requires immediate medical treatment, because it can lead to severe illness.

People who suffer from psoriasis know that this uncomfortable and at times disfiguring skin disease can be difficult and frustrating to treat. The condition comes and goes in cycles of remissions and flare-ups over a lifetime. While there are medications and other therapies that can help to clear up the patches of red, scaly, thickened skin that are the hallmark of psoriasis, there is no cure.

A variety of factors — ranging from emotional stress and trauma to streptococcal infection — can cause an episode of psoriasis. Recent research indicates that some abnormality in the immune system is the key cause of psoriasis. As many as 80% of people having flare-ups report a recent emotional trauma, such as a new job or the death of a loved one. Most doctors believe such external stressors serve as triggers for an inherited defect in immune function.

Psoriasis tends to run in families, but it may be skip generations; a grandfather and his grandson may be affected, but the child’s mother never develops the disease. Although psoriasis may be stressful and embarrassing, most outbreaks are relatively harmless. With appropriate treatment, symptoms generally subside within a few months.

SOURCES: National Institute of Arthritis and Musculoskeletal and Skin Disease. National Psoriasis Foundation. The Psoriasis Foundation. American Academy of Dermatology.

Psoriasis is a chronic inflammatory skin condition characterised by clearly defined, red and scaly plaques (thickened skin). It is classified into several subtypes.

Psoriasis affects 24% of males and females. It can start at any age including childhood, with peaks of onset at 1525 years and 5060 years. It tends to persist lifelong, fluctuating in extent and severity. It is particularly common in Caucasians, but may affect people of any race. About one third of patients with psoriasis have family members with psoriasis.

Psoriasis is multifactorial. It is classified as an immune-mediated inflammatory disease (IMID).

Genetic factors are important. An individual’s genetic profile influences their type of psoriasis and its response to treatment.

Genome-wide association studies report that HLA-Cw6 is associated with early onset psoriasis and guttate psoriasis. This major histocompatibility complex is not associated with arthritis, nail dystrophy or late onset psoriasis.

Theories about the causes of psoriasis need to explain why the skin is red, inflamed and thickened. It is clear that immune factors and inflammatory cytokines (messenger proteins) such is IL1 and TNF are responsible for the clinical features of psoriasis. Current theories are exploring the TH17 pathway and release of the cytokine IL17A.

Psoriasis usually presents with symmetrically distributed, red, scaly plaques with well-defined edges. The scale is typically silvery white, except in skin folds where the plaques often appear shiny and they may have a moist peeling surface. The most common sites are scalp, elbows and knees, but any part of the skin can be involved. The plaques are usually very persistent without treatment.

Itch is mostly mild but may be severe in some patients, leading to scratching and lichenification (thickened leathery skin with increased skin markings). Painful skin cracks or fissures may occur.

When psoriatic plaques clear up, they may leave brown or pale marks that can be expected to fade over several months.

Certain features of psoriasis can be categorised to help determine appropriate investigations and treatment pathways. Overlap may occur.

Typical patterns of psoriasis.

Post-streptococcal acute guttate psoriasis

Small plaque psoriasis

Chronic plaque psoriasis

Unstable plaque psoriasis

Flexural psoriasis

Scalp psoriasis

Sebopsoriasis

Palmoplantar psoriasis

Nail psoriasis

Erythrodermic psoriasis (rare)

Generalised pustulosis and localised palmoplantar pustulosis are no longer classified within the psoriasis spectrum.

Patients with psoriasis are more likely than other people to have other health conditions listed here.

Psoriasis is diagnosed by its clinical features. If necessary, diagnosis is supported by typical skin biopsy findings.

Medical assessment entails a careful history, examination, questioning about effect of psoriasis on daily life, and evaluation of comorbid factors.

Validated tools used to evaluate psoriasis include:

The severity of psoriasis is classified as mild in 60% of patients, moderate in 30% and severe in 10%.

Evaluation of comorbidities may include:

Patients with psoriasis should ensure they are well informed about their skin condition and its treatment. There are benefits from not smoking, avoiding excessive alcohol and maintaining optimal weight.

Mild psoriasis is generally treated with topical agents alone. Which treatment is selected may depend on body site, extent and severity of the psoriasis.

Most psoriasis centres offer phototherapy with ultraviolet (UV) radiation, often in combination with topical or systemic agents. Types of phototherapy include

Moderate to severe psoriasis warrants treatment with a systemic agent and/or phototherapy. The most common treatments are:

Other medicines occasionally used for psoriasis include:

Systemic corticosteroids are best avoided due to risk of severe withdrawal flare of psoriasis and adverse effects.

Biologics or targeted therapies are reserved for conventional treatment-resistant severe psoriasis, mainly because of expense, as side effects compare favourably with other systemic agents. These include:

Many other monoclonal antibodies are under investigation in the treatment of psoriasis.

Psoriasis is a common, chronic, genetic, systemic inflammatory disease that is characterized by symptoms and signs such as elevated itchy plaques of raised red skin covered with thick silvery scales. Psoriasis is usually found on the elbows, knees, and scalp but can often affect the legs, trunk, and nails. Psoriasis may be found on any part of the skin.

Is Psoriasis Contagious?

Psoriasis is not an infection and therefore is not contagious. Touching the affected skin and then touching someone else will not transmit psoriasis.

What Are Psoriasis Causes and Risk Factors?

The immune system plays a key role in psoriasis. In psoriasis, a certain subset of T lymphocytes (a type of white blood cell) abnormally trigger inflammation in the skin as well as other parts of the body. These T cells produce inflammatory chemicals that cause skin cells to multiply as well as producing changes in small skin blood vessels, resulting ultimately in elevated scaling plaque of psoriasis.

Psoriasis has a genetic basis and can be inherited. Some people carry genes that make them more likely to develop psoriasis. Just because a person has genes that would make him more likely to have psoriasis doesn’t mean he will have the disease. About one-third of people with psoriasis have at least one family member with the disease. Certain factors trigger psoriasis to flare up in those who have the genes.

Environmental factors such as smoking, sunburns, streptococcal sore throat, and alcoholism may affect psoriasis by increasing the frequency of flares. Injury to the skin has been known to trigger psoriasis. For example, a skin infection, skin inflammation, or even excessive scratching can activate psoriasis. A number of medications have been shown to aggravate psoriasis.

Psoriasis flare-ups can last for weeks or months. Psoriasis can go away and then return.

Plaque psoriasis is the most common type of psoriasis and is characterized by red skin covered with silvery scales and inflammation. Plaques of psoriasis vary in shape and frequently itch or burn.

Psoriasis Statistics

Approximately 1%-2% of people in the United States, or about 5.5 million, have plaque psoriasis. Up to 10% of people with plaque psoriasis also have psoriatic arthritis. Individuals with psoriatic arthritis have inflammation in their joints that could result in permanent joint damage if not treated aggressively. Recent information indicates that most patients with psoriasis are also predisposed to obesity, diabetes, and early cardiovascular diseases. It is now becoming apparent that psoriasis is not just a skin disease but can have widespread systemic effects.

Sometimes plaque psoriasis can evolve into more severe disease, such as pustular or erythrodermic psoriasis. In pustular psoriasis, the red areas on the skin contain small blisters filled with pus. In erythrodermic psoriasis, a wide area of red and scaling skin is typical, and it may be itchy and uncomfortable.

What Are Psoriasis Treatments?

There are many topical and systemic treatments for psoriasis, but it must be born in mind that although many of them are effective in improving the appearance of the skin disease, none of them cure the condition.

Psoriasis treatments reduce inflammation and clear the skin. Treatments can be divided into three main types: topical treatments, light therapy and systemic medications.

Used alone, creams and ointments that you apply to your skin can effectively treat mild to moderate psoriasis. When the disease is more severe, creams are likely to be combined with oral medications or light therapy. Topical psoriasis treatments include:

Topical corticosteroids. These drugs are the most frequently prescribed medications for treating mild to moderate psoriasis. They reduce inflammation and relieve itching and may be used with other treatments.

Mild corticosteroid ointments are usually recommended for sensitive areas, such as your face or skin folds, and for treating widespread patches of damaged skin.

Long-term use or overuse of strong corticosteroids can cause thinning of the skin. Topical corticosteroids may stop working over time. It’s usually best to use topical corticosteroids as a short-term treatment during flares.

Topical retinoids. These are vitamin A derivatives that may decrease inflammation. The most common side effect is skin irritation. These medications may also increase sensitivity to sunlight, so while using the medication apply sunscreen before going outdoors.

The risk of birth defects is far lower for topical retinoids than for oral retinoids. But tazarotene (Tazorac, Avage) isn’t recommended when you’re pregnant or breast-feeding or if you intend to become pregnant.

Calcineurin inhibitors are not recommended for long-term or continuous use because of a potential increased risk of skin cancer and lymphoma. They may be especially helpful in areas of thin skin, such as around the eyes, where steroid creams or retinoids are too irritating or may cause harmful effects.

Coal tar. Derived from coal, coal tar reduces scaling, itching and inflammation. Coal tar can irritate the skin. It’s also messy, stains clothing and bedding, and has a strong odor.

Coal tar is available in over-the-counter shampoos, creams and oils. It’s also available in higher concentrations by prescription. This treatment isn’t recommended for women who are pregnant or breast-feeding.

This treatment uses natural or artificial ultraviolet light. The simplest and easiest form of phototherapy involves exposing your skin to controlled amounts of natural sunlight.

Other forms of light therapy include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light, either alone or in combination with medications.

Psoralen plus ultraviolet A (PUVA). This form of photochemotherapy involves taking a light-sensitizing medication (psoralen) before exposure to UVA light. UVA light penetrates deeper into the skin than does UVB light, and psoralen makes the skin more responsive to UVA exposure.

This more aggressive treatment consistently improves skin and is often used for more-severe cases of psoriasis. Short-term side effects include nausea, headache, burning and itching. Long-term side effects include dry and wrinkled skin, freckles, increased sun sensitivity, and increased risk of skin cancer, including melanoma.

If you have severe psoriasis or it’s resistant to other types of treatment, your doctor may prescribe oral or injected drugs. This is known as systemic treatment. Because of severe side effects, some of these medications are used for only brief periods and may be alternated with other forms of treatment.

Although doctors choose treatments based on the type and severity of psoriasis and the areas of skin affected, the traditional approach is to start with the mildest treatments topical creams and ultraviolet light therapy (phototherapy) in those patients with typical skin lesions (plaques) and then progress to stronger ones only if necessary. Patients with pustular or erythrodermic psoriasis or associated arthritis usually need systemic therapy from the beginning of treatment. The goal is to find the most effective way to slow cell turnover with the fewest possible side effects.

There are a number of new medications currently being researched that have the potential to improve psoriasis treatment. These treatments target different proteins that work with the immune system.

A number of alternative therapies claim to ease the symptoms of psoriasis, including special diets, creams, dietary supplements and herbs. None have definitively been proved effective. But some alternative therapies are deemed generally safe, and they may be helpful to some people in reducing signs and symptoms, such as itching and scaling. These treatments would be most appropriate for those with milder, plaque disease and not for those with pustules, erythroderma or arthritis.

If you’re considering dietary supplements or other alternative therapy to ease the symptoms of psoriasis, consult your doctor. He or she can help you weigh the pros and cons of specific alternative therapies.

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Although self-help measures won’t cure psoriasis, they may help improve the appearance and feel of damaged skin. These measures may benefit you:

Coping with psoriasis can be a challenge, especially if the disease covers large areas of your body or is in places readily seen by other people, such as your face or hands. The ongoing, persistent nature of the disease and the treatment challenges only add to the burden.

Here are some ways to help you cope and to feel more in control:

You’ll likely first see your family doctor or a general practitioner. In some cases, you may be referred directly to a specialist in skin diseases (dermatologist).

Here’s some information to help you prepare for your appointment and to know what to expect from your doctor.

Psoriasis is an autoimmune disease, which means that your bodys immune system which protects you from diseases starts overacting and causing problems. If you have psoriasis, a type of white blood cells called the T cells become so active that they trigger other immune system responses, including swelling and fast turnover of skin cells.

Your skin cells grow deep in the skin and rise slowly to the surface. This is called cell turnover, and it usually takes about a month. If you have psoriasis, though, cell turnover can take only a few days. Your skin cells rise too fast and pile up on the surface, causing your skin to look red and scaly.

Some things may cause a flare, meaning your psoriasis becomes worse for a while, including:

Certain genes have been linked to psoriasis, meaning it runs in families.

Psoriasis is a skin disease that causes itchy or sore patches of thick, red skin with silvery scales. You usually get the patches on your elbows, knees, scalp, back, face, palms and feet, but they can show up on other parts of your body. Some people who have psoriasis also get a form of arthritis called psoriatic arthritis.

A problem with your immune system causes psoriasis. In a process called cell turnover, skin cells that grow deep in your skin rise to the surface. Normally, this takes a month. In psoriasis, it happens in just days because your cells rise too fast.

Psoriasis can be hard to diagnose because it can look like other skin diseases. Your doctor might need to look at a small skin sample under a microscope.

Psoriasis can last a long time, even a lifetime. Symptoms come and go. Things that make them worse include

Psoriasis usually occurs in adults. It sometimes runs in families. Treatments include creams, medicines, and light therapy.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

The horror of penile psoriasis is hard to describe to those that dont have it. Imagine your sexy, noodly appendage looking like its just been pulled through a paper shredder. Even if youre into S&M and like your sausage being butchered, its not a fun look, let me tell you!

Now imagine slicing this with a butchers knife.

Thankfully so far, knock on wood I havent had problems with P on the peepee.

Penile psoriasis, like psoriasis in general, can appear anywhere on your love vegetable from the base of the shaft all the way to the top of the glans. Even if youre circumcised or uncircumcised, it can get you. However, unlike the common plaque psoriasis, the skin looks smooth NOT rough and dry.

If you want to see what a sex machine looks like covered by psoriasis, scroll on down! If not, run away and hide in a cupboard.

The good thing about penile psoriasis is that there are many ways of relieving the physical discomfort (and no, not by massaging it with gallons of vaseline). While it may look like a desiccated salami, it can still feel great. You just have to treat it right, baby!

The more you touch it, the worse it gets. If you see psoriasis appearing, its best to go easy on the sex/masturbation, because any action will just mean further aggravating the skin and making it sore. For me, 2 to 3 days is enough for it to be back to normal.

Wear 100% cotton underwear and loose trousers. Now, you dont have to go the way of MC Hammer and get yourself parachute pants, but hipster, penis-rubbing, skin-tight jeans are a bad choice. So is tight underwear, latex, spandex and other ridiculously groin suffocating garb. Cotton allows the skin to breathe properly and absorb extra moisture, which means that any penile psoriasis wont be further aggravated by the type of clothes you wear. I stick to boxers, but Im sure Y-fronts or whatever else is fine if its cotton.

The third words of wisdom are to use moisturizer! Moisturizing the dry areas in the morning can make the daytime more tolerable; but you will have to experiment with what brands to use to get something non-greasy (John, is that a mayonnaise stain on your pants again?). For me personally, a bit of vaseline works well after the shower, but other hypoallergenic creams are just as good.

While the groin and penile area is very sensitive, and therefore can be quite difficult to treat in cases of severe penile psoriasis, it also means that it responds super quickly to creams.

The first line of attack is usually a topical treatment using a cream such as hydrocortisone. Hydrocortisone in particular is one of the weakest steroid creams you can get, and it works well in the groin area.

One word of warning since the skin is so thin, it can increase the bodys absorption of the cream to 30%. This can lead to a thinning of the skin and even discolouration. However, in my experience, if you use it SENSIBLY, it works well, even in the long-term.

For me, all it takes is 2 to 4 applications over a couple of days to stop the psoriasis before it sexually abuses my love wand. Just take a pea-sized amount and rub it in a little goes a long way down there (no pun intended!) and youll be back in business in no time.

The second treatment option is phototherapy using UVB light. It can take from 20 to 60 sessions for this to have an affect, and it also has side effects, such as leading to testicular cancer, which is why Ive never tried it. I recommend that you stick to the creams for quick relief (before exploring longer-term treatments, such as diet changes.)

Update:I just discovered this little gem and had to share it with you.

One of my onlinebuddies who getspsoriasis on the silly willy told me that he usescondoms to ease the irritation, and I have to say,his method isingenious!

If youve everheard of occlusion, this works the same way. What you do is moisturise your penis really well, then get a condom and squeeze a bit more ointment in there. Now put it over your flaccid penis and go about your day.

Youll forget that its ever there in about five minutes, and at the end of your day, your penis will start to feel human. The trick is getting the condom to stay put and not slip off. Just experiment with sizes!

Related flaky goodness

Tags: penis, psoriasis

redblob I’m just an average 28 year old living with psoriasis. Over the last decade, I’ve tried everything, from real snake poison to rubbing banana peels over my body. I’ve finally found an approach that’s working for me, and I’m sharing it with all the flakers out there. But Psoriasis Blob is not about one man, it’s a growing community of great, red people.

Psoriasis is a noncontagious, chronic skin condition that produces plaques of thickened, scaling skin. The dry flakes of skin scales result from the excessively rapid proliferation of skin cells. The proliferation of skin cells is triggered by inflammatory chemicals produced by specialized white blood cells called T-lymphocytes. Psoriasis commonly affects the skin of the elbows, knees, and scalp.

The spectrum of disease ranges from mild with limited involvement of small areas of skin to large, thick plaques to red inflamed skin affecting the entire body surface.

Psoriasis is considered an incurable, long-term (chronic) inflammatory skin condition. It has a variable course, periodically improving and worsening. It is not unusual for psoriasis to spontaneously clear for years and stay in remission. Many people note a worsening of their symptoms in the colder winter months.

Psoriasis affects all races and both sexes. Although psoriasis can be seen in people of any age, from babies to seniors, most commonly patients are first diagnosed in their early adult years. The quality of life of patients with psoriasis is often diminished because of the appearance of their skin. Recently, it has become clear that people with psoriasis are more likely to have diabetes, high blood lipids, cardiovascular disease, and a variety of other inflammatory diseases. This may reflect an inability to control inflammation. Caring for psoriasis takes medical teamwork.

No. Psoriasis is not contagious. Psoriasis is not transmitted sexually or by physical contact. Psoriasis is not caused by lifestyle, diet, or bad hygiene.

While the exact cause of psoriasis is unknown, researchers consider environmental, genetic, and immune system factors as playing roles in the establishment of the disease.

What are psoriasis causes and risk factors?

The exact cause remains unknown. A combination of elements, including genetic predisposition and environmental factors, are involved. It is common for psoriasis to be found in members of the same family. Defects in immune regulation and the control of inflammation are thought to play major roles. Certain medications like beta-blockers have been linked to psoriasis. Despite research over the past 30 years, the “master switch” that turns on psoriasis is still a mystery.

What are the different types of psoriasis?

There are several different forms of psoriasis, including plaque psoriasis or psoriasis vulgaris (common plaque type), guttate psoriasis (small, drop-like spots), inverse psoriasis (in the folds like of the underarms, navel, groin, and buttocks), and pustular psoriasis (small pus-filled yellowish blisters). When the palms and the soles are involved, this is known as palmoplantar psoriasis. In erythrodermic psoriasis, the entire skin surface is involved with the disease. Patients with this form of psoriasis often feel cold and may develop congestive heart failure if they have a preexisting heart problem. Nail psoriasis produces yellow pitted nails that can be confused with nail fungus. Scalp psoriasis can be severe enough to produce localized hair loss, plenty of dandruff, and severe itching.

Can psoriasis affect my joints?

Yes, psoriasis is associated with inflamed joints in about one-third of those affected. In fact, sometimes joint pains may be the only sign of the disorder, with completely clear skin. The joint disease associated with psoriasis is referred to as psoriatic arthritis. Patients may have inflammation of any joints (arthritis), although the joints of the hands, knees, and ankles tend to be most commonly affected. Psoriatic arthritis is an inflammatory, destructive form of arthritis and needs to be treated with medications in order to stop the disease progression.

The average age for onset of psoriatic arthritis is 30-40 years of age. Usually, the skin symptoms and signs precede the onset of the arthritis.

Can psoriasis affect only my nails?

Yes, psoriasis may involve solely the nails in a limited number of patients. Usually, the nail signs accompany the skin and arthritis symptoms and signs. Nail psoriasis is typically very difficult to treat. Treatment options are somewhat limited and include potent topical steroids applied at the nail-base cuticle, injection of steroids at the nail-base cuticle, and oral or systemic medications as described below for the treatment of psoriasis.

What are psoriasis symptoms and signs? What does psoriasis look like?

Plaque psoriasis signs and symptoms appear as red or pink small scaly bumps that merge into plaques of raised skin. Plaque psoriasis classically affects skin over the elbows, knees, and scalp and is often itchy. Although any area may be involved, plaque psoriasis tends to be more common at sites of friction, scratching, or abrasion. Sometimes pulling off one of these small dry white flakes of skin causes a tiny blood spot on the skin. This is a special diagnostic sign in psoriasis called the Auspitz sign.

Fingernails and toenails often exhibit small pits (pinpoint depressions) and/or larger yellowish-brown separations of the nail from the nail bed at the fingertip called distal onycholysis. Nail psoriasis may be confused with and incorrectly diagnosed as a fungal nail infection.

Guttate psoriasis symptoms and signs include bumps or small plaques ( inch or less) of red itchy, scaling skin that may appear explosively, affecting large parts of the skin surface simultaneously, after a sore throat.

In inverse psoriasis, genital lesions, especially in the groin and on the head of the penis, are common. Psoriasis in moist areas like the navel or the area between the buttocks (intergluteal folds) may look like flat red plaques without much scaling. This may be confused with other skin conditions like fungal infections, yeast infections, allergic rashes, or bacterial infections.

Symptoms and signs of pustular psoriasis include at rapid onset of groups of small bumps filled with pus on the torso. Patients are often systemically ill and may have a fever.

Erythrodermic psoriasis appears as extensive areas of red skin often involving the entire skin surface. Patients may often feel chilled.

Scalp psoriasis may look like severe dandruff with dry flakes and red areas of skin. It can be difficult to differentiate between scalp psoriasis and seborrheic dermatitis when only the scalp is involved. However, the treatment is often very similar for both conditions.

How do health care professionals diagnose psoriasis?

The diagnosis of psoriasis is typically made by obtaining information from the physical examination of the skin, medical history, and relevant family health history.

Sometimes lab tests, including a microscopic examination of tissue obtained from a skin biopsy, may be necessary.

Eczema vs. psoriasis

Occasionally, it can be difficult to differentiate eczematous dermatitis from psoriasis. This is when a biopsy can be quite valuable to distinguish between the two conditions. Of note, both eczematous dermatitis and psoriasis often respond to similar treatments. Certain types of eczematous dermatitis can be cured where this is not the case for psoriasis.

How many people have psoriasis?

Psoriasis is a fairly common skin condition and is estimated to affect approximately 1%-3% of the U.S. population. It currently affects roughly 7.5 million to 8.5 million people in the U.S. It is seen worldwide in about 125 million people. Interestingly, African Americans have about half the rate of psoriasis as Caucasians.

Is psoriasis contagious?

No. A person cannot catch it from someone else, and one cannot pass it to anyone else by skin-to-skin contact. Directly touching someone with psoriasis every day will never transmit the condition.

Is there a cure for psoriasis?

No, psoriasis is not currently curable. However, it can go into remission, producing an entirely normal skin surface. Ongoing research is actively making progress on finding better treatments and a possible cure in the future.

Is psoriasis hereditary?

Although psoriasis is not contagious from person to person, there is a known hereditary tendency. Therefore, family history is very helpful in making the diagnosis.

What health care specialists treat psoriasis?

Dermatologists are doctors who specialize in the diagnosis and treatment of psoriasis, and rheumatologists specialize in the treatment of joint disorders and psoriatic arthritis. Many kinds of doctors may treat psoriasis, including dermatologists, family physicians, internal medicine physicians, rheumatologists, and other medical doctors. Some patients have also seen other allied health professionals such as acupuncturists, holistic practitioners, chiropractors, and nutritionists.

The American Academy of Dermatology and the National Psoriasis Foundation are excellent sources to help find doctors who specialize in this disease. Not all dermatologists and rheumatologists treat psoriasis. The National Psoriasis Foundation has one of the most up-to-date databases of current psoriasis specialists.

It is now apparent that patients with psoriasis are prone to a variety of other disease conditions, so-called comorbidities. Cardiovascular disease, diabetes, hypertension, inflammatory bowel disease, hyperlipidemia, liver problems, and arthritis are more common in patients with psoriasis. It is very important for all patients with psoriasis to be carefully monitored by their primary care providers for these associated illnesses. The joint inflammation of psoriatic arthritis and its complications are frequently managed by rheumatologists.

What are psoriasis treatment options?

There are many effective psoriasis treatment choices. The best treatment is individually determined by the treating doctor and depends, in part, on the type of disease, the severity, and amount of skin involved and the type of insurance coverage.

For mild disease that involves only small areas of the body (less than 10% of the total skin surface), topical treatments (skin applied), such as creams, lotions, and sprays, may be very effective and safe to use. Occasionally, a small local injection of steroids directly into a tough or resistant isolated psoriatic plaque may be helpful.

For moderate to severe disease that involves much larger areas of the body (>10% or more of the total skin surface), topical products may not be effective or practical to apply. This may require ultraviolet light treatments or systemic (total body treatments such as pills or injections) medicines. Internal medications usually have greater risks. Because topical therapy has no effect on psoriatic arthritis, systemic medications are generally required to stop the progression to permanent joint destruction.

It is important to keep in mind that as with any medical condition, all medicines carry possible side effects. No medication is 100% effective for everyone, and no medication is 100% safe. The decision to use any medication requires thorough consideration and discussion with your health care provider. The risks and potential benefit of medications have to be considered for each type of psoriasis and the individual. Of two patients with precisely the same amount of disease, one may tolerate it with very little treatment, while the other may become incapacitated and require treatment internally.

A proposal to minimize the toxicity of some of these medicines has been commonly called “rotational” therapy. The idea is to change the anti-psoriasis drugs every six to 24 months in order to minimize the toxicity of one medication. Depending on the medications selected, this proposal can be an option. An exception to this proposal is the use of the newer biologic medications as described below. An individual who has been using strong topical steroids over large areas of their body for prolonged periods may benefit from stopping the steroids for a while and rotating onto a different therapy.

Coal tar shampoos are very useful in controlling psoriasis of the scalp. Using the shampoo daily can be very beneficial adjunctive therapy. There are a variety of shampoos available without a prescription. There is no evidence that one shampoo is superior to another. Generally, the selection of a tar shampoo is simply a matter of personal preference.

What oral medications are available for psoriasis?

Oral medications include methotrexate (Trexall), acitretin (Soriatane), cyclosporine (Neoral), apremilast (Otezla), and others. Oral prednisone (corticosteroid) is generally not used in psoriasis and may cause a disease flare-up if administered.

By clicking “Submit,” I agree to the MedicineNet Terms and Conditions and Privacy Policy. I also agree to receive emails from MedicineNet and I understand that I may opt out of MedicineNet subscriptions at any time.

What injections or infusions are available for psoriasis?

Recently, a new group of drugs called biologics have become available to treat psoriasis and psoriatic arthritis. They are produced by living cells cultures in an industrial setting. They are all proteins and therefore must be administered through the skin because they would otherwise be degraded during digestion. All biologics work by suppressing certain specific portions of the immune inflammatory response that are overactive in psoriasis. A convenient method of categorizing these drugs is on the basis of their site of action:

Drug choice can be complicated, and your physician will help in selecting the best option. In some patients. it may be possible to predict drug efficacy on the basis of a prospective patient’s genetics. It appears that the presence of the HLA-Cw6 gene is correlated with a beneficial response to ustekinumab.

Newer drugs are in development and no doubt will be available in the near future. As this class of drugs is fairly new, ongoing monitoring and adverse effect reporting continues and long-term safety continues to be monitored. Biologics are all comparatively expensive especially in view of the fact they none of them are curative. Recently, the FDA has attempted to address this problem by permitting the use of “biosimilar” drugs. These drugs are structurally identical to a specific biologic drug and are presumed to produce identical therapeutic responses in human beings to the original, but are produced using different methodology. Biosimilars ought to be available at some fraction of the cost of the original. If this will be an effective approach remains to be seen. The only biosimilar available currently is infliximab (Inflectra). Two other biosimilar drugs have been accepted by the FDA, an etanercept equivalent (Erelzi) and an adalimumab equivalent (Amjevita) — but currently, neither are available.

Some biologics are to be administered by self-injections for home use while others are given by intravenous infusions in the doctor’s office. Biologics have some screening requirements such as a tuberculosis screening test (TB skin test or PPD test) and other labs prior to starting therapy. As with any drug, side effects are possible with all biologic drugs. Common potential side effects include mild local injection-site reactions (redness and tenderness). There is concern of serious infections and potential malignancy with nearly all biologic drugs. Precautions include patients with known or suspected hepatitis B infection, active tuberculosis, and possibly HIV/AIDS. As a general consideration, these drugs may not be an ideal choice for patients with a history of cancer and patients actively undergoing cancer therapy. In particular, there may be an increased association of lymphoma in patients taking a biologic.

Biologics are expensive medications ranging in price from several to tens of thousands of dollars per year per person. Their use may be limited by availability, cost, and insurance approval. Not all insurance drug plans fully cover these drugs for all conditions. Patients need to check with their insurance and may require a prior authorization request for coverage approval. Some of the biologic manufacturers have patient-assistance programs to help with financial issues. Therefore, choice of the right medication for your condition depends on many factors, not all of them medical. Additionally, convenience of receiving the medication and lifestyle affect the choice of the right biologic medication.

Is there an anti-psoriasis diet?

Most patients with psoriasis seem to be overweight. Since there is a predisposition for those patients to develop cardiovascular disease and diabetes, it is suggested strongly that they try to maintain a normal body weight. Although evidence is sparse, it has been suggested that slender patients are more likely to respond to treatment.

Although dietary studies are notoriously difficult to perform and interpret, it seems likely that a diet whose fat content is composed of polyunsaturated oils like olive oil and fish oil is beneficial for psoriasis. The so-called Mediterranean diet is an example.

What about light therapy for psoriasis?

Light therapy is also called phototherapy. There are several types of medical light therapies that include PUVA (an acronym for psoralen + UVA), UVB, and narrow-band UVB. These artificial light sources have been used for decades and generally are available in only certain physician’s offices. There are a few companies who may sell light boxes or light bulbs for prescribed home light therapy.

Natural sunlight is also used to treat psoriasis. Daily short, controlled exposures to natural sunlight may help or clear psoriasis in some patients. Skin unaffected by psoriasis and sensitive areas such as the face and hands may need to be protected during sun exposure.

There are also multiple newer light sources like lasers and photodynamic therapy (use of a light activating medication and a special light source) that have been used to treat psoriasis.

PUVA is a special treatment using a photosensitizing drug and timed artificial-light exposure composed of wavelengths of ultraviolet light in the UVA spectrum. The photosensitizing drug in PUVA is called psoralen. Both the psoralen and the UVA light must be administered within one hour of each other for a response to occur. These treatments are usually given in a physician’s office two to three times per week. Several weeks of PUVA is usually required before seeing significant results. The light exposure time is gradually increased during each subsequent treatment. Psoralens may be given orally as a pill or topically as a bath or lotion. After a short incubation period, the skin is exposed to a special wavelength of ultraviolet light called UVA. Patients using PUVA are generally sun sensitive and must avoid sun exposure for a period of time after PUVA. Common side effects with PUVA include burning, aging of the skin, increased brown spots called lentigines, and an increased risk of skin cancer, including melanoma. The relative increase in skin cancer risk with PUVA treatment is controversial. PUVA treatments need to be closely monitored by a physician and discontinued when a maximum number of treatments have been reached.

Narrow-band UVB phototherapy is an artificial light treatment using very limited wavelengths of light. It is frequently given daily or two to three times per week. UVB is also a component of natural sunlight. UVB dosage is based on time and exposure is gradually increased as tolerated. Potential side effects with UVB include skin burning, premature aging, and possible increased risk of skin cancer. The relative increase in skin cancer risk with UVB treatment needs further study but is probably less than PUVA or traditional UVB.

Sometimes UVB is combined with other treatments such as tar application. Goeckerman is a special psoriasis therapy using this combination. Some centers have used this therapy in a “day care” type of setting where patients are in the psoriasis treatment clinic all day for several weeks and go home each night.

Recently, a laser (excimer laser XTRAC) has been developed that generates ultraviolet light in the same range as narrow-band ultraviolet light. This light can be beneficial for psoriasis localized to small areas of skin like the palms, soles, and scalp. It is impractical to use in in extensive disease.

What is the long-term prognosis with psoriasis? What are complications of psoriasis?

Overall, the prognosis for most patients with psoriasis is good. While it is not curable, it is controllable. As described above, recent studies show an association of psoriasis and other medical conditions, including obesity, diabetes, and heart disease.

Is it possible to prevent psoriasis?

Since psoriasis is inherited, it is impossible at this time to suggest anything that is likely to prevent its development aside from indulging in a healthy lifestyle.

What does the future hold for psoriasis?

Psoriasis research is heavily funded and holds great promise for the future. Just the last five to 10 years have produced great improvements in treatment of the disease with medications aimed at controlling precise sites of the process of inflammation. Ongoing research is needed to decipher the ultimate underlying cause of this disease.

Is there a national psoriasis support group?

Yes, the National Psoriasis Foundation (NPF) is an organization dedicated to helping patients with psoriasis and furthering research in this field. They hold national and local chapter meetings. The NPF web site (http://www.psoriasis.org/home/) shares up-to-date reliable medical information and statistics on the condition.

There are many ongoing clinical trials for psoriasis all over the United States and in the world. Many of these clinical trials are ongoing at academic or university medical centers and are frequently open to patients without cost.

Clinical trials frequently have specific requirements for types and severity of psoriasis that may be enrolled into a specific trial. Patients need to contact these centers and inquire regarding the specific study requirements. Some studies have restrictions on what recent medications have been used for psoriasis, current medication, and overall health.

Some of the many medical centers in the U.S. offering clinical trials for psoriasis include the University of California, San Francisco Department of Dermatology, the University of California, Irvine Department of Dermatology, and the St. Louis University Medical School.

Psoriasis is a common skin condition that speeds up the life cycle of skin cells. It causes cells to build up rapidly on the surface of the skin. The extra skin cells form scales and red patches that are itchy and sometimes painful.

Psoriasis is a chronic disease that often comes and goes. The main goal of treatment is to stop the skin cells from growing so quickly.

There is no cure for psoriasis, but you can manage symptoms. Lifestyle measures, such as moisturizing, quitting smoking and managing stress, may help.

Psoriasis care at Mayo Clinic

Psoriasis signs and symptoms are different for everyone. Common signs and symptoms include:

Psoriasis patches can range from a few spots of dandruff-like scaling to major eruptions that cover large areas.

Most types of psoriasis go through cycles, flaring for a few weeks or months, then subsiding for a time or even going into complete remission.

There are several types of psoriasis. These include:

Guttate psoriasis. This type primarily affects young adults and children. It’s usually triggered by a bacterial infection such as strep throat. It’s marked by small, water-drop-shaped, scaling lesions on your trunk, arms, legs and scalp.

The lesions are covered by a fine scale and aren’t as thick as typical plaques are. You may have a single outbreak that goes away on its own, or you may have repeated episodes.

Pustular psoriasis. This uncommon form of psoriasis can occur in widespread patches (generalized pustular psoriasis) or in smaller areas on your hands, feet or fingertips.

It generally develops quickly, with pus-filled blisters appearing just hours after your skin becomes red and tender. The blisters may come and go frequently. Generalized pustular psoriasis can also cause fever, chills, severe itching and diarrhea.

If you suspect that you may have psoriasis, see your doctor for an examination. Also, talk to your doctor if your psoriasis:

Seek medical advice if your signs and symptoms worsen or don’t improve with treatment. You may need a different medication or a combination of treatments to manage the psoriasis.

The cause of psoriasis isn’t fully understood, but it’s thought to be related to an immune system problem with T cells and other white blood cells, called neutrophils, in your body.

T cells normally travel through the body to defend against foreign substances, such as viruses or bacteria.

But if you have psoriasis, the T cells attack healthy skin cells by mistake, as if to heal a wound or to fight an infection.

Overactive T cells also trigger increased production of healthy skin cells, more T cells and other white blood cells, especially neutrophils. These travel into the skin causing redness and sometimes pus in pustular lesions. Dilated blood vessels in psoriasis-affected areas create warmth and redness in the skin lesions.

The process becomes an ongoing cycle in which new skin cells move to the outermost layer of skin too quickly in days rather than weeks. Skin cells build up in thick, scaly patches on the skin’s surface, continuing until treatment stops the cycle.

Just what causes T cells to malfunction in people with psoriasis isn’t entirely clear. Researchers believe both genetics and environmental factors play a role.

Psoriasis typically starts or worsens because of a trigger that you may be able to identify and avoid. Factors that may trigger psoriasis include:

Anyone can develop psoriasis, but these factors can increase your risk of developing the disease:

If you have psoriasis, you’re at greater risk of developing certain diseases. These include:

It’s easy to think of psoriasis as just a “skin condition.” But psoriasis actually starts underneath the skin. It is a chronic (long-lasting) disease of the immune system that can range from mild to severe.

Like most chronic illnesses, psoriasis may be associated with other health conditions such as psoriatic arthritis, Type 2 diabetes, and cardiovascular disease.

The good news is that there are available treatment options and strategies that can help you live well with psoriasis. Start here by learning as much as you can about psoriasis and exploring it from the inside out.

To fully understand psoriasis, you need to see whats happening underneath the skin.

What you’re watching is an example of what happens underneath your skin when you have plaque psoriasis.

While symptoms may appear on the surface of the skin, what you can see is only part of the story.

With normal skin, your body takes about 28 to 30 days to produce new skin cells and shed the old ones.

When your body has plaque psoriasis, your immune system is overactive, triggering skin inflammation and causing skin cells to be produced faster than normal. New skin cells are pushed to the skin’s surface in 3 to 4 days instead of the usual 28 to 30.

But your body can’t shed the new skin cells at that fast of a rate. So while new skin cells are being produced, the old, dead skin cells pile up on top of each other.

As more and more new skin cells are produced rapidly, the old skin cells are pushed to the surface, forming the thick, red, itchy, flaky patches known as plaques.

Articles OnWhat Is Psoriasis? – Understanding Psoriasis — the Basics What Is Psoriasis? – Understanding Psoriasis — the Basics What Is Psoriasis? – Understanding Psoriasis — the Basics What Is Psoriasis?

Unpredictable and irritating, psoriasis is one of the most baffling and persistent of skin disorders. It’s characterized by skin cells that multiply up to 10 times faster than normal. As underlying cells reach the skin’s surface and die, their sheer volume causes raised, red plaques covered with white scales. Psoriasis typically occurs on the knees, elbows, and scalp, and it can also affect the torso, palms, and soles of the feet.

The symptoms of psoriasis vary depending on the type you have. Some common symptoms for plaque psoriasis — the most common variety of the condition — include:

Psoriasis can also be associated with psoriatic arthritis, which leads to pain and swelling in the joints. The National Psoriasis Foundation estimates that between 10% to 30% of people with psoriasis also have psoriatic arthritis.

Other forms of psoriasis include:

Pustular psoriasis , characterized by red and scaly skin on the palms of the hands and/or feet with tiny pustules

Guttate psoriasis, which often starts in childhood or young adulthood, is characterized by small, red spots, mainly on the torso and limbs. Triggers may be respiratory infections, strep throat, tonsillitis, stress, injury to the skin, and use of anti-malarial and beta-blocker medications.

Inverse psoriasis, characterized by bright red, shiny lesions that appear in skin folds, such as the armpits, groin area, and under the breasts

Erythrodermic psoriasis, characterized by periodic, fiery redness of the skin and shedding of scales in sheets; this form of psoriasis, triggered by withdrawal from a systemic psoriasis treatment, severe sunburn, infection, and certain medications, requires immediate medical treatment, because it can lead to severe illness.

People who suffer from psoriasis know that this uncomfortable and at times disfiguring skin disease can be difficult and frustrating to treat. The condition comes and goes in cycles of remissions and flare-ups over a lifetime. While there are medications and other therapies that can help to clear up the patches of red, scaly, thickened skin that are the hallmark of psoriasis, there is no cure.

A variety of factors — ranging from emotional stress and trauma to streptococcal infection — can cause an episode of psoriasis. Recent research indicates that some abnormality in the immune system is the key cause of psoriasis. As many as 80% of people having flare-ups report a recent emotional trauma, such as a new job or the death of a loved one. Most doctors believe such external stressors serve as triggers for an inherited defect in immune function.

Psoriasis tends to run in families, but it may be skip generations; a grandfather and his grandson may be affected, but the child’s mother never develops the disease. Although psoriasis may be stressful and embarrassing, most outbreaks are relatively harmless. With appropriate treatment, symptoms generally subside within a few months.

SOURCES: National Institute of Arthritis and Musculoskeletal and Skin Disease. National Psoriasis Foundation. The Psoriasis Foundation. American Academy of Dermatology.

Psoriasis is a common skin condition that speeds up the life cycle of skin cells. It causes cells to build up rapidly on the surface of the skin. The extra skin cells form scales and red patches that are itchy and sometimes painful.

Psoriasis is a chronic disease that often comes and goes. The main goal of treatment is to stop the skin cells from growing so quickly.

There is no cure for psoriasis, but you can manage symptoms. Lifestyle measures, such as moisturizing, quitting smoking and managing stress, may help.

Psoriasis care at Mayo Clinic

Psoriasis signs and symptoms are different for everyone. Common signs and symptoms include:

Psoriasis patches can range from a few spots of dandruff-like scaling to major eruptions that cover large areas.

Most types of psoriasis go through cycles, flaring for a few weeks or months, then subsiding for a time or even going into complete remission.

There are several types of psoriasis. These include:

Guttate psoriasis. This type primarily affects young adults and children. It’s usually triggered by a bacterial infection such as strep throat. It’s marked by small, water-drop-shaped, scaling lesions on your trunk, arms, legs and scalp.

The lesions are covered by a fine scale and aren’t as thick as typical plaques are. You may have a single outbreak that goes away on its own, or you may have repeated episodes.

Pustular psoriasis. This uncommon form of psoriasis can occur in widespread patches (generalized pustular psoriasis) or in smaller areas on your hands, feet or fingertips.

It generally develops quickly, with pus-filled blisters appearing just hours after your skin becomes red and tender. The blisters may come and go frequently. Generalized pustular psoriasis can also cause fever, chills, severe itching and diarrhea.

If you suspect that you may have psoriasis, see your doctor for an examination. Also, talk to your doctor if your psoriasis:

Seek medical advice if your signs and symptoms worsen or don’t improve with treatment. You may need a different medication or a combination of treatments to manage the psoriasis.

The cause of psoriasis isn’t fully understood, but it’s thought to be related to an immune system problem with T cells and other white blood cells, called neutrophils, in your body.

T cells normally travel through the body to defend against foreign substances, such as viruses or bacteria.

But if you have psoriasis, the T cells attack healthy skin cells by mistake, as if to heal a wound or to fight an infection.

Overactive T cells also trigger increased production of healthy skin cells, more T cells and other white blood cells, especially neutrophils. These travel into the skin causing redness and sometimes pus in pustular lesions. Dilated blood vessels in psoriasis-affected areas create warmth and redness in the skin lesions.

The process becomes an ongoing cycle in which new skin cells move to the outermost layer of skin too quickly in days rather than weeks. Skin cells build up in thick, scaly patches on the skin’s surface, continuing until treatment stops the cycle.

Just what causes T cells to malfunction in people with psoriasis isn’t entirely clear. Researchers believe both genetics and environmental factors play a role.

Psoriasis typically starts or worsens because of a trigger that you may be able to identify and avoid. Factors that may trigger psoriasis include:

Anyone can develop psoriasis, but these factors can increase your risk of developing the disease:

If you have psoriasis, you’re at greater risk of developing certain diseases. These include:

Articles OnWhat Is Psoriasis? – Understanding Psoriasis — the Basics What Is Psoriasis? – Understanding Psoriasis — the Basics What Is Psoriasis? – Understanding Psoriasis — the Basics What Is Psoriasis?

Unpredictable and irritating, psoriasis is one of the most baffling and persistent of skin disorders. It’s characterized by skin cells that multiply up to 10 times faster than normal. As underlying cells reach the skin’s surface and die, their sheer volume causes raised, red plaques covered with white scales. Psoriasis typically occurs on the knees, elbows, and scalp, and it can also affect the torso, palms, and soles of the feet.

The symptoms of psoriasis vary depending on the type you have. Some common symptoms for plaque psoriasis — the most common variety of the condition — include:

Psoriasis can also be associated with psoriatic arthritis, which leads to pain and swelling in the joints. The National Psoriasis Foundation estimates that between 10% to 30% of people with psoriasis also have psoriatic arthritis.

Other forms of psoriasis include:

Pustular psoriasis , characterized by red and scaly skin on the palms of the hands and/or feet with tiny pustules

Guttate psoriasis, which often starts in childhood or young adulthood, is characterized by small, red spots, mainly on the torso and limbs. Triggers may be respiratory infections, strep throat, tonsillitis, stress, injury to the skin, and use of anti-malarial and beta-blocker medications.

Inverse psoriasis, characterized by bright red, shiny lesions that appear in skin folds, such as the armpits, groin area, and under the breasts

Erythrodermic psoriasis, characterized by periodic, fiery redness of the skin and shedding of scales in sheets; this form of psoriasis, triggered by withdrawal from a systemic psoriasis treatment, severe sunburn, infection, and certain medications, requires immediate medical treatment, because it can lead to severe illness.

People who suffer from psoriasis know that this uncomfortable and at times disfiguring skin disease can be difficult and frustrating to treat. The condition comes and goes in cycles of remissions and flare-ups over a lifetime. While there are medications and other therapies that can help to clear up the patches of red, scaly, thickened skin that are the hallmark of psoriasis, there is no cure.

A variety of factors — ranging from emotional stress and trauma to streptococcal infection — can cause an episode of psoriasis. Recent research indicates that some abnormality in the immune system is the key cause of psoriasis. As many as 80% of people having flare-ups report a recent emotional trauma, such as a new job or the death of a loved one. Most doctors believe such external stressors serve as triggers for an inherited defect in immune function.

Psoriasis tends to run in families, but it may be skip generations; a grandfather and his grandson may be affected, but the child’s mother never develops the disease. Although psoriasis may be stressful and embarrassing, most outbreaks are relatively harmless. With appropriate treatment, symptoms generally subside within a few months.

SOURCES: National Institute of Arthritis and Musculoskeletal and Skin Disease. National Psoriasis Foundation. The Psoriasis Foundation. American Academy of Dermatology.

Psoriasis is a noncontagious, chronic skin condition that produces plaques of thickened, scaling skin. The dry flakes of skin scales result from the excessively rapid proliferation of skin cells. The proliferation of skin cells is triggered by inflammatory chemicals produced by specialized white blood cells called T-lymphocytes. Psoriasis commonly affects the skin of the elbows, knees, and scalp.

The spectrum of disease ranges from mild with limited involvement of small areas of skin to large, thick plaques to red inflamed skin affecting the entire body surface.

Psoriasis is considered an incurable, long-term (chronic) inflammatory skin condition. It has a variable course, periodically improving and worsening. It is not unusual for psoriasis to spontaneously clear for years and stay in remission. Many people note a worsening of their symptoms in the colder winter months.

Psoriasis affects all races and both sexes. Although psoriasis can be seen in people of any age, from babies to seniors, most commonly patients are first diagnosed in their early adult years. The quality of life of patients with psoriasis is often diminished because of the appearance of their skin. Recently, it has become clear that people with psoriasis are more likely to have diabetes, high blood lipids, cardiovascular disease, and a variety of other inflammatory diseases. This may reflect an inability to control inflammation. Caring for psoriasis takes medical teamwork.

No. Psoriasis is not contagious. Psoriasis is not transmitted sexually or by physical contact. Psoriasis is not caused by lifestyle, diet, or bad hygiene.

While the exact cause of psoriasis is unknown, researchers consider environmental, genetic, and immune system factors as playing roles in the establishment of the disease.

What are psoriasis causes and risk factors?

The exact cause remains unknown. A combination of elements, including genetic predisposition and environmental factors, are involved. It is common for psoriasis to be found in members of the same family. Defects in immune regulation and the control of inflammation are thought to play major roles. Certain medications like beta-blockers have been linked to psoriasis. Despite research over the past 30 years, the “master switch” that turns on psoriasis is still a mystery.

What are the different types of psoriasis?

There are several different forms of psoriasis, including plaque psoriasis or psoriasis vulgaris (common plaque type), guttate psoriasis (small, drop-like spots), inverse psoriasis (in the folds like of the underarms, navel, groin, and buttocks), and pustular psoriasis (small pus-filled yellowish blisters). When the palms and the soles are involved, this is known as palmoplantar psoriasis. In erythrodermic psoriasis, the entire skin surface is involved with the disease. Patients with this form of psoriasis often feel cold and may develop congestive heart failure if they have a preexisting heart problem. Nail psoriasis produces yellow pitted nails that can be confused with nail fungus. Scalp psoriasis can be severe enough to produce localized hair loss, plenty of dandruff, and severe itching.

Can psoriasis affect my joints?

Yes, psoriasis is associated with inflamed joints in about one-third of those affected. In fact, sometimes joint pains may be the only sign of the disorder, with completely clear skin. The joint disease associated with psoriasis is referred to as psoriatic arthritis. Patients may have inflammation of any joints (arthritis), although the joints of the hands, knees, and ankles tend to be most commonly affected. Psoriatic arthritis is an inflammatory, destructive form of arthritis and needs to be treated with medications in order to stop the disease progression.

The average age for onset of psoriatic arthritis is 30-40 years of age. Usually, the skin symptoms and signs precede the onset of the arthritis.

Can psoriasis affect only my nails?

Yes, psoriasis may involve solely the nails in a limited number of patients. Usually, the nail signs accompany the skin and arthritis symptoms and signs. Nail psoriasis is typically very difficult to treat. Treatment options are somewhat limited and include potent topical steroids applied at the nail-base cuticle, injection of steroids at the nail-base cuticle, and oral or systemic medications as described below for the treatment of psoriasis.

What are psoriasis symptoms and signs? What does psoriasis look like?

Plaque psoriasis signs and symptoms appear as red or pink small scaly bumps that merge into plaques of raised skin. Plaque psoriasis classically affects skin over the elbows, knees, and scalp and is often itchy. Although any area may be involved, plaque psoriasis tends to be more common at sites of friction, scratching, or abrasion. Sometimes pulling off one of these small dry white flakes of skin causes a tiny blood spot on the skin. This is a special diagnostic sign in psoriasis called the Auspitz sign.

Fingernails and toenails often exhibit small pits (pinpoint depressions) and/or larger yellowish-brown separations of the nail from the nail bed at the fingertip called distal onycholysis. Nail psoriasis may be confused with and incorrectly diagnosed as a fungal nail infection.

Guttate psoriasis symptoms and signs include bumps or small plaques ( inch or less) of red itchy, scaling skin that may appear explosively, affecting large parts of the skin surface simultaneously, after a sore throat.

In inverse psoriasis, genital lesions, especially in the groin and on the head of the penis, are common. Psoriasis in moist areas like the navel or the area between the buttocks (intergluteal folds) may look like flat red plaques without much scaling. This may be confused with other skin conditions like fungal infections, yeast infections, allergic rashes, or bacterial infections.

Symptoms and signs of pustular psoriasis include at rapid onset of groups of small bumps filled with pus on the torso. Patients are often systemically ill and may have a fever.

Erythrodermic psoriasis appears as extensive areas of red skin often involving the entire skin surface. Patients may often feel chilled.

Scalp psoriasis may look like severe dandruff with dry flakes and red areas of skin. It can be difficult to differentiate between scalp psoriasis and seborrheic dermatitis when only the scalp is involved. However, the treatment is often very similar for both conditions.

How do health care professionals diagnose psoriasis?

The diagnosis of psoriasis is typically made by obtaining information from the physical examination of the skin, medical history, and relevant family health history.

Sometimes lab tests, including a microscopic examination of tissue obtained from a skin biopsy, may be necessary.

Eczema vs. psoriasis

Occasionally, it can be difficult to differentiate eczematous dermatitis from psoriasis. This is when a biopsy can be quite valuable to distinguish between the two conditions. Of note, both eczematous dermatitis and psoriasis often respond to similar treatments. Certain types of eczematous dermatitis can be cured where this is not the case for psoriasis.

How many people have psoriasis?

Psoriasis is a fairly common skin condition and is estimated to affect approximately 1%-3% of the U.S. population. It currently affects roughly 7.5 million to 8.5 million people in the U.S. It is seen worldwide in about 125 million people. Interestingly, African Americans have about half the rate of psoriasis as Caucasians.

Is psoriasis contagious?

No. A person cannot catch it from someone else, and one cannot pass it to anyone else by skin-to-skin contact. Directly touching someone with psoriasis every day will never transmit the condition.

Is there a cure for psoriasis?

No, psoriasis is not currently curable. However, it can go into remission, producing an entirely normal skin surface. Ongoing research is actively making progress on finding better treatments and a possible cure in the future.

Is psoriasis hereditary?

Although psoriasis is not contagious from person to person, there is a known hereditary tendency. Therefore, family history is very helpful in making the diagnosis.

What health care specialists treat psoriasis?

Dermatologists are doctors who specialize in the diagnosis and treatment of psoriasis, and rheumatologists specialize in the treatment of joint disorders and psoriatic arthritis. Many kinds of doctors may treat psoriasis, including dermatologists, family physicians, internal medicine physicians, rheumatologists, and other medical doctors. Some patients have also seen other allied health professionals such as acupuncturists, holistic practitioners, chiropractors, and nutritionists.

The American Academy of Dermatology and the National Psoriasis Foundation are excellent sources to help find doctors who specialize in this disease. Not all dermatologists and rheumatologists treat psoriasis. The National Psoriasis Foundation has one of the most up-to-date databases of current psoriasis specialists.

It is now apparent that patients with psoriasis are prone to a variety of other disease conditions, so-called comorbidities. Cardiovascular disease, diabetes, hypertension, inflammatory bowel disease, hyperlipidemia, liver problems, and arthritis are more common in patients with psoriasis. It is very important for all patients with psoriasis to be carefully monitored by their primary care providers for these associated illnesses. The joint inflammation of psoriatic arthritis and its complications are frequently managed by rheumatologists.

What are psoriasis treatment options?

There are many effective psoriasis treatment choices. The best treatment is individually determined by the treating doctor and depends, in part, on the type of disease, the severity, and amount of skin involved and the type of insurance coverage.

For mild disease that involves only small areas of the body (less than 10% of the total skin surface), topical treatments (skin applied), such as creams, lotions, and sprays, may be very effective and safe to use. Occasionally, a small local injection of steroids directly into a tough or resistant isolated psoriatic plaque may be helpful.

For moderate to severe disease that involves much larger areas of the body (>10% or more of the total skin surface), topical products may not be effective or practical to apply. This may require ultraviolet light treatments or systemic (total body treatments such as pills or injections) medicines. Internal medications usually have greater risks. Because topical therapy has no effect on psoriatic arthritis, systemic medications are generally required to stop the progression to permanent joint destruction.

It is important to keep in mind that as with any medical condition, all medicines carry possible side effects. No medication is 100% effective for everyone, and no medication is 100% safe. The decision to use any medication requires thorough consideration and discussion with your health care provider. The risks and potential benefit of medications have to be considered for each type of psoriasis and the individual. Of two patients with precisely the same amount of disease, one may tolerate it with very little treatment, while the other may become incapacitated and require treatment internally.

A proposal to minimize the toxicity of some of these medicines has been commonly called “rotational” therapy. The idea is to change the anti-psoriasis drugs every six to 24 months in order to minimize the toxicity of one medication. Depending on the medications selected, this proposal can be an option. An exception to this proposal is the use of the newer biologic medications as described below. An individual who has been using strong topical steroids over large areas of their body for prolonged periods may benefit from stopping the steroids for a while and rotating onto a different therapy.

Coal tar shampoos are very useful in controlling psoriasis of the scalp. Using the shampoo daily can be very beneficial adjunctive therapy. There are a variety of shampoos available without a prescription. There is no evidence that one shampoo is superior to another. Generally, the selection of a tar shampoo is simply a matter of personal preference.

What oral medications are available for psoriasis?

Oral medications include methotrexate (Trexall), acitretin (Soriatane), cyclosporine (Neoral), apremilast (Otezla), and others. Oral prednisone (corticosteroid) is generally not used in psoriasis and may cause a disease flare-up if administered.

What injections or infusions are available for psoriasis?

Recently, a new group of drugs called biologics have become available to treat psoriasis and psoriatic arthritis. They are produced by living cells cultures in an industrial setting. They are all proteins and therefore must be administered through the skin because they would otherwise be degraded during digestion. All biologics work by suppressing certain specific portions of the immune inflammatory response that are overactive in psoriasis. A convenient method of categorizing these drugs is on the basis of their site of action:

Drug choice can be complicated, and your physician will help in selecting the best option. In some patients. it may be possible to predict drug efficacy on the basis of a prospective patient’s genetics. It appears that the presence of the HLA-Cw6 gene is correlated with a beneficial response to ustekinumab.

Newer drugs are in development and no doubt will be available in the near future. As this class of drugs is fairly new, ongoing monitoring and adverse effect reporting continues and long-term safety continues to be monitored. Biologics are all comparatively expensive especially in view of the fact they none of them are curative. Recently, the FDA has attempted to address this problem by permitting the use of “biosimilar” drugs. These drugs are structurally identical to a specific biologic drug and are presumed to produce identical therapeutic responses in human beings to the original, but are produced using different methodology. Biosimilars ought to be available at some fraction of the cost of the original. If this will be an effective approach remains to be seen. The only biosimilar available currently is infliximab (Inflectra). Two other biosimilar drugs have been accepted by the FDA, an etanercept equivalent (Erelzi) and an adalimumab equivalent (Amjevita) — but currently, neither are available.

Some biologics are to be administered by self-injections for home use while others are given by intravenous infusions in the doctor’s office. Biologics have some screening requirements such as a tuberculosis screening test (TB skin test or PPD test) and other labs prior to starting therapy. As with any drug, side effects are possible with all biologic drugs. Common potential side effects include mild local injection-site reactions (redness and tenderness). There is concern of serious infections and potential malignancy with nearly all biologic drugs. Precautions include patients with known or suspected hepatitis B infection, active tuberculosis, and possibly HIV/AIDS. As a general consideration, these drugs may not be an ideal choice for patients with a history of cancer and patients actively undergoing cancer therapy. In particular, there may be an increased association of lymphoma in patients taking a biologic.

Biologics are expensive medications ranging in price from several to tens of thousands of dollars per year per person. Their use may be limited by availability, cost, and insurance approval. Not all insurance drug plans fully cover these drugs for all conditions. Patients need to check with their insurance and may require a prior authorization request for coverage approval. Some of the biologic manufacturers have patient-assistance programs to help with financial issues. Therefore, choice of the right medication for your condition depends on many factors, not all of them medical. Additionally, convenience of receiving the medication and lifestyle affect the choice of the right biologic medication.

Is there an anti-psoriasis diet?

Most patients with psoriasis seem to be overweight. Since there is a predisposition for those patients to develop cardiovascular disease and diabetes, it is suggested strongly that they try to maintain a normal body weight. Although evidence is sparse, it has been suggested that slender patients are more likely to respond to treatment.

Although dietary studies are notoriously difficult to perform and interpret, it seems likely that a diet whose fat content is composed of polyunsaturated oils like olive oil and fish oil is beneficial for psoriasis. The so-called Mediterranean diet is an example.

What about light therapy for psoriasis?

Light therapy is also called phototherapy. There are several types of medical light therapies that include PUVA (an acronym for psoralen + UVA), UVB, and narrow-band UVB. These artificial light sources have been used for decades and generally are available in only certain physician’s offices. There are a few companies who may sell light boxes or light bulbs for prescribed home light therapy.

Natural sunlight is also used to treat psoriasis. Daily short, controlled exposures to natural sunlight may help or clear psoriasis in some patients. Skin unaffected by psoriasis and sensitive areas such as the face and hands may need to be protected during sun exposure.

There are also multiple newer light sources like lasers and photodynamic therapy (use of a light activating medication and a special light source) that have been used to treat psoriasis.

PUVA is a special treatment using a photosensitizing drug and timed artificial-light exposure composed of wavelengths of ultraviolet light in the UVA spectrum. The photosensitizing drug in PUVA is called psoralen. Both the psoralen and the UVA light must be administered within one hour of each other for a response to occur. These treatments are usually given in a physician’s office two to three times per week. Several weeks of PUVA is usually required before seeing significant results. The light exposure time is gradually increased during each subsequent treatment. Psoralens may be given orally as a pill or topically as a bath or lotion. After a short incubation period, the skin is exposed to a special wavelength of ultraviolet light called UVA. Patients using PUVA are generally sun sensitive and must avoid sun exposure for a period of time after PUVA. Common side effects with PUVA include burning, aging of the skin, increased brown spots called lentigines, and an increased risk of skin cancer, including melanoma. The relative increase in skin cancer risk with PUVA treatment is controversial. PUVA treatments need to be closely monitored by a physician and discontinued when a maximum number of treatments have been reached.

Narrow-band UVB phototherapy is an artificial light treatment using very limited wavelengths of light. It is frequently given daily or two to three times per week. UVB is also a component of natural sunlight. UVB dosage is based on time and exposure is gradually increased as tolerated. Potential side effects with UVB include skin burning, premature aging, and possible increased risk of skin cancer. The relative increase in skin cancer risk with UVB treatment needs further study but is probably less than PUVA or traditional UVB.

Sometimes UVB is combined with other treatments such as tar application. Goeckerman is a special psoriasis therapy using this combination. Some centers have used this therapy in a “day care” type of setting where patients are in the psoriasis treatment clinic all day for several weeks and go home each night.

Recently, a laser (excimer laser XTRAC) has been developed that generates ultraviolet light in the same range as narrow-band ultraviolet light. This light can be beneficial for psoriasis localized to small areas of skin like the palms, soles, and scalp. It is impractical to use in in extensive disease.

What is the long-term prognosis with psoriasis? What are complications of psoriasis?

Overall, the prognosis for most patients with psoriasis is good. While it is not curable, it is controllable. As described above, recent studies show an association of psoriasis and other medical conditions, including obesity, diabetes, and heart disease.

Is it possible to prevent psoriasis?

Since psoriasis is inherited, it is impossible at this time to suggest anything that is likely to prevent its development aside from indulging in a healthy lifestyle.

What does the future hold for psoriasis?

Psoriasis research is heavily funded and holds great promise for the future. Just the last five to 10 years have produced great improvements in treatment of the disease with medications aimed at controlling precise sites of the process of inflammation. Ongoing research is needed to decipher the ultimate underlying cause of this disease.

Is there a national psoriasis support group?

Yes, the National Psoriasis Foundation (NPF) is an organization dedicated to helping patients with psoriasis and furthering research in this field. They hold national and local chapter meetings. The NPF web site (http://www.psoriasis.org/home/) shares up-to-date reliable medical information and statistics on the condition.

There are many ongoing clinical trials for psoriasis all over the United States and in the world. Many of these clinical trials are ongoing at academic or university medical centers and are frequently open to patients without cost.

Clinical trials frequently have specific requirements for types and severity of psoriasis that may be enrolled into a specific trial. Patients need to contact these centers and inquire regarding the specific study requirements. Some studies have restrictions on what recent medications have been used for psoriasis, current medication, and overall health.

Some of the many medical centers in the U.S. offering clinical trials for psoriasis include the University of California, San Francisco Department of Dermatology, the University of California, Irvine Department of Dermatology, and the St. Louis University Medical School.

Psoriasis is a noncontagious, chronic skin condition that produces plaques of thickened, scaling skin. The dry flakes of skin scales result from the excessively rapid proliferation of skin cells. The proliferation of skin cells is triggered by inflammatory chemicals produced by specialized white blood cells called T-lymphocytes. Psoriasis commonly affects the skin of the elbows, knees, and scalp.

The spectrum of disease ranges from mild with limited involvement of small areas of skin to large, thick plaques to red inflamed skin affecting the entire body surface.

Psoriasis is considered an incurable, long-term (chronic) inflammatory skin condition. It has a variable course, periodically improving and worsening. It is not unusual for psoriasis to spontaneously clear for years and stay in remission. Many people note a worsening of their symptoms in the colder winter months.

Psoriasis affects all races and both sexes. Although psoriasis can be seen in people of any age, from babies to seniors, most commonly patients are first diagnosed in their early adult years. The quality of life of patients with psoriasis is often diminished because of the appearance of their skin. Recently, it has become clear that people with psoriasis are more likely to have diabetes, high blood lipids, cardiovascular disease, and a variety of other inflammatory diseases. This may reflect an inability to control inflammation. Caring for psoriasis takes medical teamwork.

No. Psoriasis is not contagious. Psoriasis is not transmitted sexually or by physical contact. Psoriasis is not caused by lifestyle, diet, or bad hygiene.

While the exact cause of psoriasis is unknown, researchers consider environmental, genetic, and immune system factors as playing roles in the establishment of the disease.

What are psoriasis causes and risk factors?

The exact cause remains unknown. A combination of elements, including genetic predisposition and environmental factors, are involved. It is common for psoriasis to be found in members of the same family. Defects in immune regulation and the control of inflammation are thought to play major roles. Certain medications like beta-blockers have been linked to psoriasis. Despite research over the past 30 years, the “master switch” that turns on psoriasis is still a mystery.

What are the different types of psoriasis?

There are several different forms of psoriasis, including plaque psoriasis or psoriasis vulgaris (common plaque type), guttate psoriasis (small, drop-like spots), inverse psoriasis (in the folds like of the underarms, navel, groin, and buttocks), and pustular psoriasis (small pus-filled yellowish blisters). When the palms and the soles are involved, this is known as palmoplantar psoriasis. In erythrodermic psoriasis, the entire skin surface is involved with the disease. Patients with this form of psoriasis often feel cold and may develop congestive heart failure if they have a preexisting heart problem. Nail psoriasis produces yellow pitted nails that can be confused with nail fungus. Scalp psoriasis can be severe enough to produce localized hair loss, plenty of dandruff, and severe itching.

Can psoriasis affect my joints?

Yes, psoriasis is associated with inflamed joints in about one-third of those affected. In fact, sometimes joint pains may be the only sign of the disorder, with completely clear skin. The joint disease associated with psoriasis is referred to as psoriatic arthritis. Patients may have inflammation of any joints (arthritis), although the joints of the hands, knees, and ankles tend to be most commonly affected. Psoriatic arthritis is an inflammatory, destructive form of arthritis and needs to be treated with medications in order to stop the disease progression.

The average age for onset of psoriatic arthritis is 30-40 years of age. Usually, the skin symptoms and signs precede the onset of the arthritis.

Can psoriasis affect only my nails?

Yes, psoriasis may involve solely the nails in a limited number of patients. Usually, the nail signs accompany the skin and arthritis symptoms and signs. Nail psoriasis is typically very difficult to treat. Treatment options are somewhat limited and include potent topical steroids applied at the nail-base cuticle, injection of steroids at the nail-base cuticle, and oral or systemic medications as described below for the treatment of psoriasis.

What are psoriasis symptoms and signs? What does psoriasis look like?

Plaque psoriasis signs and symptoms appear as red or pink small scaly bumps that merge into plaques of raised skin. Plaque psoriasis classically affects skin over the elbows, knees, and scalp and is often itchy. Although any area may be involved, plaque psoriasis tends to be more common at sites of friction, scratching, or abrasion. Sometimes pulling off one of these small dry white flakes of skin causes a tiny blood spot on the skin. This is a special diagnostic sign in psoriasis called the Auspitz sign.

Fingernails and toenails often exhibit small pits (pinpoint depressions) and/or larger yellowish-brown separations of the nail from the nail bed at the fingertip called distal onycholysis. Nail psoriasis may be confused with and incorrectly diagnosed as a fungal nail infection.

Guttate psoriasis symptoms and signs include bumps or small plaques ( inch or less) of red itchy, scaling skin that may appear explosively, affecting large parts of the skin surface simultaneously, after a sore throat.

In inverse psoriasis, genital lesions, especially in the groin and on the head of the penis, are common. Psoriasis in moist areas like the navel or the area between the buttocks (intergluteal folds) may look like flat red plaques without much scaling. This may be confused with other skin conditions like fungal infections, yeast infections, allergic rashes, or bacterial infections.

Symptoms and signs of pustular psoriasis include at rapid onset of groups of small bumps filled with pus on the torso. Patients are often systemically ill and may have a fever.

Erythrodermic psoriasis appears as extensive areas of red skin often involving the entire skin surface. Patients may often feel chilled.

Scalp psoriasis may look like severe dandruff with dry flakes and red areas of skin. It can be difficult to differentiate between scalp psoriasis and seborrheic dermatitis when only the scalp is involved. However, the treatment is often very similar for both conditions.

How do health care professionals diagnose psoriasis?

The diagnosis of psoriasis is typically made by obtaining information from the physical examination of the skin, medical history, and relevant family health history.

Sometimes lab tests, including a microscopic examination of tissue obtained from a skin biopsy, may be necessary.

Eczema vs. psoriasis

Occasionally, it can be difficult to differentiate eczematous dermatitis from psoriasis. This is when a biopsy can be quite valuable to distinguish between the two conditions. Of note, both eczematous dermatitis and psoriasis often respond to similar treatments. Certain types of eczematous dermatitis can be cured where this is not the case for psoriasis.

How many people have psoriasis?

Psoriasis is a fairly common skin condition and is estimated to affect approximately 1%-3% of the U.S. population. It currently affects roughly 7.5 million to 8.5 million people in the U.S. It is seen worldwide in about 125 million people. Interestingly, African Americans have about half the rate of psoriasis as Caucasians.

Is psoriasis contagious?

No. A person cannot catch it from someone else, and one cannot pass it to anyone else by skin-to-skin contact. Directly touching someone with psoriasis every day will never transmit the condition.

Is there a cure for psoriasis?

No, psoriasis is not currently curable. However, it can go into remission, producing an entirely normal skin surface. Ongoing research is actively making progress on finding better treatments and a possible cure in the future.

Is psoriasis hereditary?

Although psoriasis is not contagious from person to person, there is a known hereditary tendency. Therefore, family history is very helpful in making the diagnosis.

What health care specialists treat psoriasis?

Dermatologists are doctors who specialize in the diagnosis and treatment of psoriasis, and rheumatologists specialize in the treatment of joint disorders and psoriatic arthritis. Many kinds of doctors may treat psoriasis, including dermatologists, family physicians, internal medicine physicians, rheumatologists, and other medical doctors. Some patients have also seen other allied health professionals such as acupuncturists, holistic practitioners, chiropractors, and nutritionists.

The American Academy of Dermatology and the National Psoriasis Foundation are excellent sources to help find doctors who specialize in this disease. Not all dermatologists and rheumatologists treat psoriasis. The National Psoriasis Foundation has one of the most up-to-date databases of current psoriasis specialists.

It is now apparent that patients with psoriasis are prone to a variety of other disease conditions, so-called comorbidities. Cardiovascular disease, diabetes, hypertension, inflammatory bowel disease, hyperlipidemia, liver problems, and arthritis are more common in patients with psoriasis. It is very important for all patients with psoriasis to be carefully monitored by their primary care providers for these associated illnesses. The joint inflammation of psoriatic arthritis and its complications are frequently managed by rheumatologists.

What are psoriasis treatment options?

There are many effective psoriasis treatment choices. The best treatment is individually determined by the treating doctor and depends, in part, on the type of disease, the severity, and amount of skin involved and the type of insurance coverage.

For mild disease that involves only small areas of the body (less than 10% of the total skin surface), topical treatments (skin applied), such as creams, lotions, and sprays, may be very effective and safe to use. Occasionally, a small local injection of steroids directly into a tough or resistant isolated psoriatic plaque may be helpful.

For moderate to severe disease that involves much larger areas of the body (>10% or more of the total skin surface), topical products may not be effective or practical to apply. This may require ultraviolet light treatments or systemic (total body treatments such as pills or injections) medicines. Internal medications usually have greater risks. Because topical therapy has no effect on psoriatic arthritis, systemic medications are generally required to stop the progression to permanent joint destruction.

It is important to keep in mind that as with any medical condition, all medicines carry possible side effects. No medication is 100% effective for everyone, and no medication is 100% safe. The decision to use any medication requires thorough consideration and discussion with your health care provider. The risks and potential benefit of medications have to be considered for each type of psoriasis and the individual. Of two patients with precisely the same amount of disease, one may tolerate it with very little treatment, while the other may become incapacitated and require treatment internally.

A proposal to minimize the toxicity of some of these medicines has been commonly called “rotational” therapy. The idea is to change the anti-psoriasis drugs every six to 24 months in order to minimize the toxicity of one medication. Depending on the medications selected, this proposal can be an option. An exception to this proposal is the use of the newer biologic medications as described below. An individual who has been using strong topical steroids over large areas of their body for prolonged periods may benefit from stopping the steroids for a while and rotating onto a different therapy.

Coal tar shampoos are very useful in controlling psoriasis of the scalp. Using the shampoo daily can be very beneficial adjunctive therapy. There are a variety of shampoos available without a prescription. There is no evidence that one shampoo is superior to another. Generally, the selection of a tar shampoo is simply a matter of personal preference.

What oral medications are available for psoriasis?

Oral medications include methotrexate (Trexall), acitretin (Soriatane), cyclosporine (Neoral), apremilast (Otezla), and others. Oral prednisone (corticosteroid) is generally not used in psoriasis and may cause a disease flare-up if administered.

What injections or infusions are available for psoriasis?

Recently, a new group of drugs called biologics have become available to treat psoriasis and psoriatic arthritis. They are produced by living cells cultures in an industrial setting. They are all proteins and therefore must be administered through the skin because they would otherwise be degraded during digestion. All biologics work by suppressing certain specific portions of the immune inflammatory response that are overactive in psoriasis. A convenient method of categorizing these drugs is on the basis of their site of action:

Drug choice can be complicated, and your physician will help in selecting the best option. In some patients. it may be possible to predict drug efficacy on the basis of a prospective patient’s genetics. It appears that the presence of the HLA-Cw6 gene is correlated with a beneficial response to ustekinumab.

Newer drugs are in development and no doubt will be available in the near future. As this class of drugs is fairly new, ongoing monitoring and adverse effect reporting continues and long-term safety continues to be monitored. Biologics are all comparatively expensive especially in view of the fact they none of them are curative. Recently, the FDA has attempted to address this problem by permitting the use of “biosimilar” drugs. These drugs are structurally identical to a specific biologic drug and are presumed to produce identical therapeutic responses in human beings to the original, but are produced using different methodology. Biosimilars ought to be available at some fraction of the cost of the original. If this will be an effective approach remains to be seen. The only biosimilar available currently is infliximab (Inflectra). Two other biosimilar drugs have been accepted by the FDA, an etanercept equivalent (Erelzi) and an adalimumab equivalent (Amjevita) — but currently, neither are available.

Some biologics are to be administered by self-injections for home use while others are given by intravenous infusions in the doctor’s office. Biologics have some screening requirements such as a tuberculosis screening test (TB skin test or PPD test) and other labs prior to starting therapy. As with any drug, side effects are possible with all biologic drugs. Common potential side effects include mild local injection-site reactions (redness and tenderness). There is concern of serious infections and potential malignancy with nearly all biologic drugs. Precautions include patients with known or suspected hepatitis B infection, active tuberculosis, and possibly HIV/AIDS. As a general consideration, these drugs may not be an ideal choice for patients with a history of cancer and patients actively undergoing cancer therapy. In particular, there may be an increased association of lymphoma in patients taking a biologic.

Biologics are expensive medications ranging in price from several to tens of thousands of dollars per year per person. Their use may be limited by availability, cost, and insurance approval. Not all insurance drug plans fully cover these drugs for all conditions. Patients need to check with their insurance and may require a prior authorization request for coverage approval. Some of the biologic manufacturers have patient-assistance programs to help with financial issues. Therefore, choice of the right medication for your condition depends on many factors, not all of them medical. Additionally, convenience of receiving the medication and lifestyle affect the choice of the right biologic medication.

Is there an anti-psoriasis diet?

Most patients with psoriasis seem to be overweight. Since there is a predisposition for those patients to develop cardiovascular disease and diabetes, it is suggested strongly that they try to maintain a normal body weight. Although evidence is sparse, it has been suggested that slender patients are more likely to respond to treatment.

Although dietary studies are notoriously difficult to perform and interpret, it seems likely that a diet whose fat content is composed of polyunsaturated oils like olive oil and fish oil is beneficial for psoriasis. The so-called Mediterranean diet is an example.

What about light therapy for psoriasis?

Light therapy is also called phototherapy. There are several types of medical light therapies that include PUVA (an acronym for psoralen + UVA), UVB, and narrow-band UVB. These artificial light sources have been used for decades and generally are available in only certain physician’s offices. There are a few companies who may sell light boxes or light bulbs for prescribed home light therapy.

Natural sunlight is also used to treat psoriasis. Daily short, controlled exposures to natural sunlight may help or clear psoriasis in some patients. Skin unaffected by psoriasis and sensitive areas such as the face and hands may need to be protected during sun exposure.

There are also multiple newer light sources like lasers and photodynamic therapy (use of a light activating medication and a special light source) that have been used to treat psoriasis.

PUVA is a special treatment using a photosensitizing drug and timed artificial-light exposure composed of wavelengths of ultraviolet light in the UVA spectrum. The photosensitizing drug in PUVA is called psoralen. Both the psoralen and the UVA light must be administered within one hour of each other for a response to occur. These treatments are usually given in a physician’s office two to three times per week. Several weeks of PUVA is usually required before seeing significant results. The light exposure time is gradually increased during each subsequent treatment. Psoralens may be given orally as a pill or topically as a bath or lotion. After a short incubation period, the skin is exposed to a special wavelength of ultraviolet light called UVA. Patients using PUVA are generally sun sensitive and must avoid sun exposure for a period of time after PUVA. Common side effects with PUVA include burning, aging of the skin, increased brown spots called lentigines, and an increased risk of skin cancer, including melanoma. The relative increase in skin cancer risk with PUVA treatment is controversial. PUVA treatments need to be closely monitored by a physician and discontinued when a maximum number of treatments have been reached.

Narrow-band UVB phototherapy is an artificial light treatment using very limited wavelengths of light. It is frequently given daily or two to three times per week. UVB is also a component of natural sunlight. UVB dosage is based on time and exposure is gradually increased as tolerated. Potential side effects with UVB include skin burning, premature aging, and possible increased risk of skin cancer. The relative increase in skin cancer risk with UVB treatment needs further study but is probably less than PUVA or traditional UVB.

Sometimes UVB is combined with other treatments such as tar application. Goeckerman is a special psoriasis therapy using this combination. Some centers have used this therapy in a “day care” type of setting where patients are in the psoriasis treatment clinic all day for several weeks and go home each night.

Recently, a laser (excimer laser XTRAC) has been developed that generates ultraviolet light in the same range as narrow-band ultraviolet light. This light can be beneficial for psoriasis localized to small areas of skin like the palms, soles, and scalp. It is impractical to use in in extensive disease.

What is the long-term prognosis with psoriasis? What are complications of psoriasis?

Overall, the prognosis for most patients with psoriasis is good. While it is not curable, it is controllable. As described above, recent studies show an association of psoriasis and other medical conditions, including obesity, diabetes, and heart disease.

Is it possible to prevent psoriasis?

Since psoriasis is inherited, it is impossible at this time to suggest anything that is likely to prevent its development aside from indulging in a healthy lifestyle.

What does the future hold for psoriasis?

Psoriasis research is heavily funded and holds great promise for the future. Just the last five to 10 years have produced great improvements in treatment of the disease with medications aimed at controlling precise sites of the process of inflammation. Ongoing research is needed to decipher the ultimate underlying cause of this disease.

Is there a national psoriasis support group?

Yes, the National Psoriasis Foundation (NPF) is an organization dedicated to helping patients with psoriasis and furthering research in this field. They hold national and local chapter meetings. The NPF web site (http://www.psoriasis.org/home/) shares up-to-date reliable medical information and statistics on the condition.

There are many ongoing clinical trials for psoriasis all over the United States and in the world. Many of these clinical trials are ongoing at academic or university medical centers and are frequently open to patients without cost.

Clinical trials frequently have specific requirements for types and severity of psoriasis that may be enrolled into a specific trial. Patients need to contact these centers and inquire regarding the specific study requirements. Some studies have restrictions on what recent medications have been used for psoriasis, current medication, and overall health.

Some of the many medical centers in the U.S. offering clinical trials for psoriasis include the University of California, San Francisco Department of Dermatology, the University of California, Irvine Department of Dermatology, and the St. Louis University Medical School.

It’s easy to think of psoriasis as just a “skin condition.” But psoriasis actually starts underneath the skin. It is a chronic (long-lasting) disease of the immune system that can range from mild to severe.

Like most chronic illnesses, psoriasis may be associated with other health conditions such as psoriatic arthritis, Type 2 diabetes, and cardiovascular disease.

The good news is that there are available treatment options and strategies that can help you live well with psoriasis. Start here by learning as much as you can about psoriasis and exploring it from the inside out.

To fully understand psoriasis, you need to see whats happening underneath the skin.

What you’re watching is an example of what happens underneath your skin when you have plaque psoriasis.

While symptoms may appear on the surface of the skin, what you can see is only part of the story.

With normal skin, your body takes about 28 to 30 days to produce new skin cells and shed the old ones.

When your body has plaque psoriasis, your immune system is overactive, triggering skin inflammation and causing skin cells to be produced faster than normal. New skin cells are pushed to the skin’s surface in 3 to 4 days instead of the usual 28 to 30.

But your body can’t shed the new skin cells at that fast of a rate. So while new skin cells are being produced, the old, dead skin cells pile up on top of each other.

As more and more new skin cells are produced rapidly, the old skin cells are pushed to the surface, forming the thick, red, itchy, flaky patches known as plaques.